Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Sep;144(3):e20190128.
doi: 10.1542/peds.2019-0128.

Prenatal Opioid Exposure: Neurodevelopmental Consequences and Future Research Priorities

Elisabeth Conradt  1 , Tess Flannery  2 , Judy L Aschner  3   4 , Robert D Annett  5 , Lisa A Croen  6 , Cristiane S Duarte  7   8 , Alexander M Friedman  9 , Constance Guille  10 , Monique M Hedderson  6 , Julie A Hofheimer  11 , Miranda R Jones  12 , Christine Ladd-Acosta  12   13 , Monica McGrath  12 , Angela Moreland  14 , Jenae M Neiderhiser  15 , Ruby H N Nguyen  16 , Jonathan Posner  8 , Judith L Ross  17 , David A Savitz  18 , Steven J Ondersma  19 , Barry M Lester  20   21
Affiliations
Review

Prenatal Opioid Exposure: Neurodevelopmental Consequences and Future Research Priorities

Elisabeth Conradt et al. Pediatrics. 2019 Sep.

Abstract

Neonatal opioid withdrawal syndrome (NOWS) has risen in prevalence from 1.2 per 1000 births in 2000 to 5.8 per 1000 births in 2012. Symptoms in neonates may include high-pitched cry, tremors, feeding difficulty, hypertonia, watery stools, and breathing problems. However, little is known about the neurodevelopmental consequences of prenatal opioid exposure in infancy, early childhood, and middle childhood. Even less is known about the cognitive, behavioral, and academic outcomes of children who develop NOWS. We review the state of the literature on the neurodevelopmental consequences of prenatal opioid exposure with a particular focus on studies in which NOWS outcomes were examined. Aiming to reduce the incidence of prenatal opioid exposure in the near future, we highlight the need for large studies with prospectively recruited participants and longitudinal designs, taking into account confounding factors such as socioeconomic status, institutional variations in care, and maternal use of other substances, to independently assess the full impact of NOWS. As a more immediate solution, we provide an agenda for future research that leverages the National Institutes of Health Environmental Influences on Child Health Outcomes program to address many of the serious methodologic gaps in the literature, and we answer key questions regarding the short- and long-term neurodevelopmental health of children with prenatal opioid exposure.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Number of publications on the neurodevelopmental outcome of children with prenatal opioid exposure by year (1975–2018; N = 52).
FIGURE 2
FIGURE 2
Number and type of neurodevelopmental outcomes examined in studies of children with prenatal opioid exposure.
FIGURE 3
FIGURE 3
PRISMA flowchart revealing selection of articles included in the review.
FIGURE 4
FIGURE 4
Covariates examined in the neurodevelopmental literature of children with prenatal opioid exposure.
FIGURE 5
FIGURE 5
Number of publications on children with prenatal opioid exposure in which NOWS was examined as an outcome.
FIGURE 6
FIGURE 6
Number of cohorts in the ECHO program with data on prenatal opioid exposure, NOWS diagnoses, neurodevelopmental outcomes in infancy and childhood, and sociodemographic confounders.
See this image and copyright information in PMC

References

    1. Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid use disorder documented at delivery hospitalization - United States, 1999-2014. MMWR Morb Mortal Wkly Rep. 2018;67(31):845–849 - PMC - PubMed
    1. Holmes AV, Atwood EC, Whalen B, et al. Rooming-in to treat neonatal abstinence syndrome: improved family-centered care at lower cost. Pediatrics. 2016;137(6):e20152929. - PubMed
    1. Ko JY, Patrick SW, Tong VT, et al. Incidence of neonatal abstinence syndrome - 28 states, 1999-2013. MMWR Morb Mortal Wkly Rep. 2016;65(31):799–802 - PubMed
    1. Reddy UM, Davis JM, Ren Z, Greene MF; Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes Workshop Invited Speakers . Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstet Gynecol. 2017;130(1):10–28 - PMC - PubMed
    1. Finnegan LP, Kaltenbach K. Neonatal Abstinence Syndrome In: Hoekelman RA, Nelson NM, Seidel HM, eds. Primary Pediatric Care, 2nd ed St Louis, MO: Mosby; 1992:pp 1367–1378

Publication types