A Systematic Study on Prenatal Opioid Exposure: A Review of Neurodevelopmental Consequences

A systematic review using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted to evaluate the potential adverse impacts on neurodevelopment associated with prenatal opiate exposure.

After applying exclusion criteria to the identified collection of studies, 86 studies were included in this review. Each article was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. Results were grouped into 6 neurobehavioral function domains (executive, language, general development, motor, neurosensory, and socioemotional) and 1 neuroimaging domain.

Risk difference analyses showed the neurosensory domain in children prenatally exposed to opioid had highest risk of impairment (76.9%), whereas the executive domain had lowest risk (44.8%). The meta-analysis of pooled estimates after statistical adjustments associated with the Egger's test results showed effect size (Hedge's g) was largest in the socioemotional domain (-1.14; 95% CI, -1.61 to -0.66) and smallest in the general development domain (-0.44; 95% CI, -0.70 to -0.18). Neuroimaging studies on prenatal exposure to opioid were limited and varied in the techniques and topographical focus in their approaches, resulting in a heterogenous body of literature.

Maternal opioid use during pregnancy can serve as a risk indicator for an at-risk child and the potential need for monitoring the child's neurodevelopmental growth. The conclusions related to the direct teratogenic effects of maternal opioid use, however, are often limited by poor experimental and statistical controls used to address other substances and social adversity that co-occur with opioid use.