Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study

Abstract

Objectives: To quantify well-child visits by age 2 years and developmental screening at the 18-month enhanced well-child visit among children with prenatal opioid exposure (POE) and to identify factors associated with study outcomes.

Design: Population-based cohort study.

Setting: Ontario, Canada.

Participants: 22 276 children with POE born 2014-2018 were classified as (1) 1-29 days of prescribed opioid analgesia, (2) 30+ days of prescribed opioid analgesia, (3) medication for opioid use disorder (MOUD), (4) MOUD and opioid analgesia, or (5) unregulated opioids.

Main outcome measures: Attending ≥5 well-child visits by age 2 years and the 18-month enhanced well-child visit. Modified Poisson regression was used to examine factors associated with outcomes.

Results: Children with POE to 1-29 days of analgesics were most likely to attend ≥5 well-child visits (61.2%). Compared with these children, adjusted relative risks (aRRs) for ≥5 well-child visits were lower among those exposed to 30+ days of opioid analgesics (0.95, 95% CI 0.91 to 0.99), MOUD (0.83, 95% CI 0.79 to 0.88), MOUD and opioid analgesics (0.78 95% CI 0.68 to 0.90) and unregulated opioids (0.89, 95% CI 0.83 to 0.95). Relative to children with POE to 1-29 days of analgesics (58.5%), respective aRRs for the 18-month enhanced well-child visit were 0.92 (95% CI 0.88 to 0.96), 0.76 (95% CI 0.72 to 0.81), 0.76 (95% CI 0.66 to 0.87) and 0.82 (95% CI 0.76 to 0.88). Having a regular primary care provider was positively associated with study outcomes; socioeconomic disadvantage, rurality and maternal mental health were negatively associated.

Conclusion: Well-child visits are low in children following POE, especially among offspring of mothers receiving MOUD or unregulated opioids. Strategies to improve attendance will be important for child outcomes.

Keywords: Child Development; Epidemiology; Healthcare Disparities; Paediatrics; Primary Health Care.

Figure 1

Per cent of children with ≥5 physician visits for well-child care and developmental screening at the 18-month enhanced well-child visit by type of prenatal opioid exposure. *Indicates a meaningful difference compared with the analgesic 1–29 days group according to standardised differences of >0.10. Bars represent 95% CIs. MOUD, medication for opioid use disorder.

Figure 2

Factors associated with ≥5 physician visits for well-child care in the first 2 years of life among infants with prenatal opioid exposure. Adjusted for year of birth, infant sex, gestational age, multiple births, admission to neonatal intensive care unit and complex chronic medical conditions at birth hospitalisation and maternal non-opioid drug-related hospital care in the 2 years before conception. Missing deprivation quintile: 93/944 (9.9%), aRR 0.28, 95% CI 0.23 to 0.34. Modified Poisson regression was used to generate aRRs and 95% CIs. aRR, adjusted relative risk; FP, family physician; GP, general practitioner; MOUD, medication for opioid use disorder.

Figure 3

Factors associated with developmental screening at the 18-month enhanced well-child visit among infants with prenatal opioid exposure. Adjusted for year of birth, infant sex, gestational age, multiple births, admission to neonatal intensive care unit and complex chronic medical conditions at birth hospitalisation and maternal non-opioid drug-related hospital care in the 2 years before conception and immigrant status. Missing deprivation quintile: 104/944 (11.0%), aRR 0.28, 95% CI 0.23 to 0.34. Modified Poisson regression was used to generate aRRs and 95% CIs. aRR, adjusted relative risk; MOUD, medication for opioid use disorder.