The effects of prenatal exposure to opioids on early childhood development: context matters most

ABSTRACT

Introduction

The opioid crisis has brought an increasing focus on the long-term outcomes of children following prenatal opioid exposure. Evidence to date has been conflicting, which has caused confusion and concern amongst parents, caregivers, social service providers, medical providers and policy makers.

Methods

This review systematically evaluated the highest quality studies relating prenatal exposure to opioids with early childhood developmental outcomes. It focused on developmental outcomes as measured by the Bayley Scales of Infant and Toddler Development, encompassing cognitive, motor, and psychosocial domains of child development.

Results

Although several articles reported correlations between prenatal opioid exposure and poor early childhood developmental outcomes, these relationships were no longer statistically significant after adjusting for socio-environmental factors.

Conclusion

Additional research is needed to determine the extent of any relationship of socio-environmental factors with early childhood development in children prenatally exposed to opioids. This review suggests that socio-environmental factors may be significantly related to poor early childhood outcomes in the presence of prenatal opioid exposure.

KEYWORDS:

• Bayley scales of infant and toddler development
• prenatal opioid exposure
• socio-environmental factors in child development
• maternal opioid use

Article highlights

• There is inadequate evidence to support the assertion that prenatal opioid exposure is associated with detrimental early childhood developmental outcomes.

• There is evidence to support the assertion that, in particular, socio-environmental factors (for example, home environment, socio-economic status) may be associated with adverse child developmental outcomes in prenatally exposed children.

• Further studies should clearly define opioid exposure groups, include appropriate non-exposed comparator groups, and sufficiently measure potential confounders of child developmental outcomes (including socio-environmental factors). Such actions will advance the evaluation of the role of prenatal opioid exposure on early childhood development.

• There are major health, social, and legal ramifications that result from overattributing harms to the child from prenatal opioid exposure. Focus needs to be given to approaches for improving the resilience factors that support healthy child development for children with prenatal opioid exposure.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

G Carter performed data abstraction, review of studies, data management and results and manuscript preparation. S McGlothlin and S McLaurin-Jiang contributed to review of all studies, data abstraction and draft editing. H E Jones planned the project and obtained project funding, contributed to review of all studies, consulted on data analysis, and contributed to draft editing. R B Carlson developed search terms, completed search, developed PRIMSA figure and reviewed all drafts. K E O’Grady assisted in data abstraction, data analyses and draft editing. All authors approved the final manuscript for submission.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2024.2365331

Additional information

Funding

This paper was funded by the National Institute on Drug Abuse (1R01DA047867).