Teacher-reported kindergarten development among children exposed to prescription opioids during pregnancy

Few studies have provided inconsistent findings on the neurodevelopmental impact of prescription prenatal opioid exposure (PPOE). In this study, we examined the association between PPOE and developmental vulnerability later in childhood.

This was a matched cohort study using the Manitoba Population Research Data Repository. This cohort included dyads with children born in Manitoba, Canada between 2005-2011 with follow up until 2016. Each exposed child was matched to up to four controls based on birthing parent's age, gestational age, sex, kindergarten year, and income quintile. A sibling cohort was created to compare the outcomes between exposed and unexposed siblings. PPOE was defined as filling ≥ 2 prescriptions for opioids at any time during pregnancy. Of the 973 children with PPOE, the majority (94%) had low-potency opioid exposure, primarily codeine. The Early Development Instrument (EDI) was used to assess developmental vulnerability in kindergarten. Multivariable logistic regression models were used to adjust for confounders.

Of the 103,905 eligible children, 51% of the exposed group (n = 973) were developmentally vulnerable in 1 or more domains, compared with 32% of the control group (n = 3,814) (Adjusted Odds Ratio [AOR] 1.46; 95% CI 1.23-1.71). Children in the exposed group had a significantly higher likelihood of being vulnerable in all domains: physical health and well-being (AOR 1.31; 95%CI 1.08-1.59), communication skills and general knowledge (AOR 1.53;95%CI 1.25-1.88), language and cognitive development (AOR 1.53;95%CI 1.25-1.86), social competence (AOR 1.60;95%CI 1.32-1.95); emotional maturity domain was the least affected (AOR 1.25;95%CI 1.01-1.55). There was a higher risk of developmental vulnerability in children exposed to opioids in early pregnancy, longer durations and higher opioid dose. In the sibling cohort, no significant differences were observed in the EDI outcomes between exposed and unexposed siblings (AOR 0.92; 95% CI 0.58-1.46).

In the matched cohort study, exposure to prescription opioids during pregnancy was associated with a higher risk of developmental vulnerability later in childhood. In the sibling analysis, no differences were observed. These data strongly suggest that families should be offered early and long-term developmental screening and family-centered support.