Association of Timing and Duration of Prenatal Analgesic Opioid Exposure With Attention-Deficit/Hyperactivity Disorder in Children

Abstract

Key Points Question Is prenatal analgesic opioid exposure associated with attention-deficit/hyperactivity disorder (ADHD) in children? Findings In this cohort study of 73 480 children, with a mean follow-up of 11 years, no association between timing of analgesic opioid exposure during pregnancy and ADHD was found. The risk of ADHD diagnosis was elevated after exposure to opioids for 5 or more weeks compared with exposure for 4 weeks or less. Meaning The increased risk of ADHD observed in this study may be driven by longer duration of exposure; however, the role of residual or unmeasured confounding cannot be excluded, and this finding requires further study.

Global Brain Functional Network Connectivity in Infants With Prenatal Opioid Exposure

“…While a few studies indicate increased risks for educational delay, lower IQ, and poor language performance in children with POE, other studies show no significant differences in cognitive outcomes (63)(64)(65)(66)(67). There is, however, greater evidence to suggest an increased risk of poor long-term behavioral outcomes in children with POE, including difficulties with executive functioning (67), attention deficit hyperactivity disorder (ADHD) (68,69) and autism spectrum disorders (ASD) (70,71). Children with POE and a history of NOWS are shown to be more likely to have poor neurodevelopmental consequences including lower IQ, poor educational testing performance, lower attention, meet disability criteria, and require additional classroom therapies and services when compared to children with POE who did not develop NOWS, or healthy controls (18,(71)(72)(73)(74).…”

Analysis of Prenatal Exposure to Opioid Analgesics and Scholastic Skills in Children in Fifth Grade in Norway

“…Two recent studies 10 , 11 suggested that longer prenatal opioid analgesic exposures were associated with adverse neurodevelopmental outcomes. In the present study, we found that prenatal opioid analgesic exposures in two to three 4-week intervals were associated with low literacy and numeracy scores (wβ, −0.19; 95% CI, −0.35 to −0 04).…”

“…However, mothers who reported use during 2 or more 4-week periods are more likely to have consumed a higher total dose. 11 The MoBa participation rate was 41%; thus, our cohort had a potential self-selection bias of the healthiest women. 63 , 64 When interpreting our results, one should keep in mind that the generalizability may be limited to families that are above average in socioeconomic resources.…”

“…However, prenatal exposures for 5 or more weeks slightly increased the risk of an attention-deficit/hyperactivity disorder diagnosis, compared with shorter exposures (hazard ratio, 1.60; 95% CI, 1.04-2.47). 11 Similarly, Wen et al 10 reported that prenatal exposures for more than 14 days or exposures to high cumulative opioid doses increased the risk of neurodevelopmental disorders (hazard ratio range, 1.22-1.70), compared with no exposure.…”

“…To our knowledge, only 4 previous studies have examined the outcomes of prenatal exposure to opioid analgesics and child neurodevelopment. 9 , 10 , 11 , 12 , 13 Three of those studies 11 , 12 , 13 were based on a large Norwegian birth cohort. Skovlund et al 12 , 13 reported that prenatal analgesic opioid exposure was not associated with impaired language competence or communication skills in preschool children.…”