Prenatal Opioid Exposure and Risk of Neuropsychiatric Disorders in Children

A large study from South Korea was published last week with headlines like this;

• Opioids in Pregnancy ‘Not Linked’ to High Risk of Child Disorders

• Prenatal Opioid Exposure Not Tied to Neuropsychiatric Disorders in Offspring

Could this be true? An exploration of the data is necessary to confirm or deny this broad-reaching statement.

Title: Prenatal opioid exposure and subsequent risk of neuropsychiatric disorders in children: nationwide birth cohort study in South Korea

Published in BMJ, April 24, 2024

Summary in plain English :

This study of over 3 million children is one of the largest to track prenatal opioid exposure. In the sample of nearly all infants born in South Korea, from January 2009 to December 2017, there were 216,000 iopioid-exposed infants. The study ended in December 2020, allowing the researchers to follow children who had aged 3 to 10 years. Capping the age at 10 years is the first flaw in relating the study results to the study headlines. The majority of neuropsychiatric disorders, such as depression, anxiety, mood disorders and eating disorders, are diagnosed after the age of 10. Is declaring opioid-exposed children not at an increased risk even accurate?

The infants in this study were exposed only to prescription opioids. These opioids were taken to alleviate pain and 97% were either Hydrocodone or Tramadol. None of the babies in this study were exposed to illicit opioids. The data showed which part of the pregnancy moms were in when prescribed opioid medications. It cannot be known whether prescriptions were filled or taken, so babies deemed opioid-exposed may include unexposed babies as well. This can underestimate the adverse effects of opioid exposure to the fetus.

The conclusion of the article states; “Opioid use during pregnancy was not associated with a substantial increase in the risk of neuropsychiatric disorders in the offspring. A slightly increased risk of neuropsychiatric disorders was observed, but this should not be considered clinically meaningful given the observational nature of the study, and limited to high opioid dose, more than one opioid used, longer duration of exposure, opioid exposure during early pregnancy, and only to some neuropsychiatric disorders.”

While a substantial increase in risk was not seen with lower opioid doses taken after the first trimester of pregnancy, wouldn’t a more informative and truthful headline read, “Opioid use during pregnancy is associated with neuropsychiatric disorders when taken at high doses, over 60 days, or when taken during the first trimester.”

When examining the risk to benefit ratio, let’s think carefully about what the risk actually is. The study states, “Prenatal opioid exposure modestly increased the risk of severe neuropsychiatric disorders [including,] mood disorders, attention deficit hyperactivity disorder, and intellectual disability in the child.” While the risk may be modest, is a severe disorder afflicting your child preferred to the relief during pregnancy of pain?That’s a decision no mom wants to make, but when forced to choose, she should be fully educated on the science. Reading just the article headline communicates a different picture.

This robust study can be helpful to many within the medical field. Much new information is accessible when read in its entirety. However, in a fast-paced world where headlines can be the only way people get their news, misleading summaries can cause life-long harm.

Many thanks to the authors of this article: Kang J, Kim H J, Kim T, Lee H, Kim M, Lee S W et al.

The full report is accessible here: https://doi.org/10.1136/bmj-2023-077664