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Immediate and Long-Term Outcomes of Neonatal Opioid Exposure

Opioid abuse, especially prescription pain relievers, is a national epidemic.

The most recent prevalence statistics I could find, from the National Institude of Drug Abuse for 2017, show:

  • About 3% of 12-17 year-olds have used prescription pain killers in the past year

  • About 7% of 18-25 year-olds have used prescription pain killers in the past year

  • 3% of adults ages 26 and older have used prescription pain killers in the past year

With this overall increase in use has come a significant increase in opioid use during pregnancy. In 2014, 6.5 out of every 1000 mothers had an opioid use disorder, according to the CDC (up from 1.5 per 1000 in 1999).

Correspondingly, there has been a dramatic increase in babies born with Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome, with NIDA estimating that 1 baby with NAS/NOWS is born every 15 minutes.

NAS/NOWS includes symptoms of opiate withdrawal that typically show up 24-96 hours after birth, and can include:

  • Central nervous system signs like tremors, irritability, high-pitched crying, sleep disturbances, tight muscles tone, hyperactive reflexes, myoclonic jerks, and (rarely) seizures

  • Autonomic signs like sweating, fever, yawning, sneezing, rapid breathing, and nasal congestion, and

  • Gastrointestinal signs like poor feeding, vomiting and loose stools or diarrhea

Unfortunately, due the high incidence of opioid use during pregnancy, psychologists who work with children need to be very current on the literature on the impact of opioid use during pregnancy on child development. Here's my summary, which I'll update as I learn more:

Immediate Outcomes:

In addition to NAS/NOWS at birth, immediate outcomes of prenatal opioid exposure are:

The negative effects do not seem to be as grave for children who were exposed to opioid agonists like methadone or buprenorphine (used for treatment) during pregnancy (see also this study). Most studies find few direct impacts from opioid agonists on early development, aside from reduced head circumference, increased muscle tension, and delayed acquisition of motor milestones. In addition, studies show these concerns seem to resolve. However, imaging studies have shown reduced white matter tract abnormalities (not attributable to the reduced head circumference) in children exposed to methadone during prenatal development. This suggests at least a small direct teratological effect of opioid agonists.

Later Outcomes: Later outcomes of prenatal opioid exposure include:

  • The drug-exposed group displayed smaller neuroanatomical volumes (0.70 SD difference in total brain volume, p = 0.001), smaller cortical surface areas and thinner cortices than the comparison group. The birth weight accounted for some of the intergroup differences. Neuroanatomical characteristics partially mediated group differences in cognitive function.

The outcome risks seem to be the same for mothers treated with buprenorphine by prescription according to this study. However, these risks do not seem to be present in mothers treated with methadone during pregnancy. Interestingly, research comparing buprenorphine to methadone suggest infants do better with buprenorphine (see also this study). However, the late outcome research seems to come to the opposite conclusion.

Family Factors:

Some research suggests these long-term outcomes could be due to the risk factors that are likely to be comorbid in families where maternal opioid use would take place, rather than due to the opioid exposure itself. This is also important for families where the mother was treated with methadone. While methadone exposure seems to have limited direct impact on cognitive development, being raised in a household that includes high levels of family stress does contribute to poorer long-term outcomes.

Animal Models:

Possibly in contrast to the family factors research above, rodent models suggest perinatal exposure to opiates may directly disrupt the normal development of dopaminergic reward-related circuits, leading to hyperactive and dysregulated behavior.

Overview of Neonatal Exposure Research:

This article provides an overview of what we know (and still have to learn) about neonatal exposure to alcohol, nicotine, cocaine, amphetamine, Ecstasy, and opiates (among other drugs): Ross, E. J., Graham, D. L., Money, K. M., & Stanwood, G. D. (2015). Developmental consequences of fetal exposure to drugs: what we know and what we still must learn. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 40(1), 61–87.

Leading Researchers (e.g., for use in a Pub Med search):

Links for Teens:

In looking into this topic, I came across the following resources for teens about opioid use. I'm popping in this post in case they're helpful to anyone:

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