Annual Research Review: Prenatal opioid exposure – a two‐generation approach to conceptualizing neurodevelopmental outcomes

Abstract

Opioid use during pregnancy impacts the health and well‐being of two generations: the pregnant person and the child. The factors that increase risk for opioid use in the adult, as well as those that perpetuate risk for the caregiver and child, oftentimes replicate across generations and may be more likely to affect child neurodevelopment than the opioid exposure itself. In this article, we review the prenatal opioid exposure literature with the perspective that this is not a singular event but an intergenerational cascade of events. We highlight several mechanisms of transmission across generations: biological factors, including genetics and epigenetics and the gut–brain axis; parent–child mechanisms, such as prepregnancy experience of child maltreatment, quality of parenting, infant behaviors, neonatal opioid withdrawal diagnosis, and broader environmental contributors including poverty, violence exposure, stigma, and Child Protective Services involvement. We conclude by describing ways in which intergenerational transmission can be disrupted by early intervention.

Maternal Substance Use and Early-Life Adversity: Inducing Drug Dependence in Offspring, Interactions, Mechanisms, and Treatments

“…Furthermore, this intergenerational cascade is influenced by various parent-child interactions, such as past events of child maltreatment, the level of parenting quality, infant behaviors, the diagnosis of neonatal opioid withdrawal, and wider environmental concerns such as stigmatization by society and destitution, engagement with childcare agencies, and exposure to aggression. 45 …”

Early emotional caregiving environment and associations with memory performance and hippocampal volume in adolescents with prenatal drug exposure

“…A growing literature supports models of heterogeneity in susceptibility to environmental risk that examine the possibility that teratogenic and maternal risk factors interact to influence child behavioral outcomes (Konijnenberg et al, 2015;Schuetze et al, 2021). Overall, the literature suggests that a history of PDE is associated with potential risk factors that may contribute to a negative caregiving environment and, in turn, have negative developmental consequences (Conradt et al, 2023). Drug use during pregnancy is associated with significant maternal PTSD symptoms, increased likelihood of violence exposure, and higher incidence of psychopathology (Min et al, 2018;Punamäki et al, 2021).…”

Expansion and commentary on a two generation approach to prenatal opioid exposure – a commentary on Conradt et al. (2023)

“…These factors are both intrinsic to the caregiver–child dyad such as genetics and epigenetics as well as extrinsic such as social environment and enrichment. Additional layers of complexity may be at play within families with parental substance use, as outlined by Conradt et al (2023) in their review article titled “Prenatal Opioid Exposure: A Two‐Generation Approach to Conceptualizing Risk for Child Psychopathology.”. Conradt et al provide an overarching synthesis of many findings related to substance use that goes beyond the in utero exposure to the transgenerational interface of pregnancy and early childhood, including biologic sensitivities such as genetic predisposition, overrepresentation of social risk factors including early adversities of caregivers and poverty, and transgenerational interactional susceptibilities.…”