Short term, low dose prescription opioids after the first trimester of pregnancy seem relatively safe in terms of neuropsychiatric disorders in children. But caution is needed for higher doses over longer periods, say experts.
Opioid use during pregnancy is not associated with a substantial increase in the risk of neuropsychiatric disorders such as ADHD in children, finds a large study from South Korea published by The BMJ.
A slightly increased risk of neuropsychiatric disorders was found, but the researchers say this should not be considered clinically meaningful because it was limited to mothers exposed to more than one opioid prescription, high doses, and over longer time periods during pregnancy.
According to 2019 data from the Centers for Disease Control and Prevention, around 7% of women in the United States were prescribed opioids during pregnancy.
Previous studies have shown mixed findings on the association between opioid use in pregnancy and various health outcomes in offspring due to small sample sizes and short follow-up periods.
To address this knowledge gap, an international team of researchers set out to investigate the potential association between opioid exposure during pregnancy and risk of neuropsychiatric disorders in offspring.
Their findings are based on data from the National Health Insurance Service (NHIS) of South Korea for 3,128,571 infants born between 2010 and 2017 and 2,299,664 mothers (average age 32).
Mothers were grouped according to dose, duration, and frequency of opioid prescriptions during pregnancy and infants were followed up for an average of six years.
Factors including mother’s age at delivery, household income and pre-existing health conditions, and infant sex, birth weight and breastfeeding history were taken into account. A sibling comparison analysis was also carried out to account for genetics, lifestyle, and environmental influences.
Overall, 216,012 (7%) of the 3,128,571 infants were exposed to opioids during pregnancy (prenatal exposure).
A small increased risk of neuropsychiatric disorders was found among children exposed to prescription opioids during pregnancy compared with those not exposed, but the researchers interpret this as clinically insignificant.
And no significant association was noted in the sibling comparison group.