Early developmental trajectory of children with prenatal alcohol and opioid exposure

Abstract

Background: With significant increases in opioid use/misuse and persistent high prevalence of prenatal alcohol exposure (PAE), identifying infants at risk for long-term developmental sequelae due to these exposures remains an urgent need. This study reports on developmental outcomes in young children from a prospective cohort, ENRICH-1, which recruited pregnant women and followed up maternal-infant pairs.

Methods: Subjects were assigned to four study groups based on prenatal use of medications for opioid use disorder (MOUD), PAE, MOUD+PAE, and unexposed controls (UC). Mixed effects modeling was used to evaluate changes in the Bayley Scales of Infant Development-III (BSID-III) Cognitive, Language, and Motor scores between 6 and 20 months.

Results: There was a significant three-way interaction (MOUD-by-PAE-by-Time) with respect to the BSID-III Cognitive (p = 0.045) and Motor (p = 0.033) scales. Significant changes between the two evaluations were observed for MOUD group in Cognitive and Language scores; for PAE group in Cognitive, Language, and Motor scores, and for MOUD+PAE group in Language scores after adjusting for child sex and family socio-economic status. The developmental scores for the UC remained stable.

Conclusion: Observed decline in neurodevelopmental scores during the first 2 years of life emphasizes the importance of a longitudinal approach when evaluating children with prenatal polysubstance exposure.

Impact: BSID-III scores were stable during the first 2 years of life for unexposed children. BSID-III scores declined for children with prenatal exposures to alcohol and/or opioids. Standard developmental tests may not be sensitive enough during the first year of life. Findings emphasize the need for repeated evaluations of children who are at high risk.

Figure 1.. Changes in BSID-III Cognitive, Language, and Motor Scores from 6 Months to 20 Months by Study Group Adjusted for Child Sex and Family SES.

The change in BSID-III mean scores from 6 months to 20 months is shown in a for Cognitive, c for Language, and e for Motor. The p-value is for the three-way interaction (MOUD-by-PAE-by-Time) with respect to the BSID-III score. Bar plots summarize statistical significance of pairwise comparisons for the differences between 6 months and 20 months within each study group (row directly above bars), as well as comparisons of each study group to the UC group at 20 months (top 3 rows in plot); b is for BSID-III Cognitive score, d is for BSID-III Language score, and f is for BSID-III Motor score. NS, non-significant (p ≥0.05) *** p < 0.001, ** p < 0.01, * p < 0.05