New findings on a not-so-new epidemic have two key implications for psychiatrists.
Children exposed to opioids in utero are at significant risk for health problems, including preterm birth, neurodevelopmental issues in infancy, and psychological and medical issues in childhood, according to a study published in JAMA Network Open. Azuine and colleagues1 sought to determine risk factors for women who used opioids in pregnancy and found significant short- and long-term health consequences that may include emotional issues as well as conduct disorder and ADHD.
To investigate the issue, researchers looked at 8509 mother-newborn pairs from the Boston Birth Cohort (BBC), a large sample of an urban, low-income population from its inception in 1998. The cohort followed 3153 children throughout their lives until aged 21 years. Mothers’ self-reports and/or electronic health records determined that 454 (5.3%) children had in utero opioid exposure or neonatal abstinence syndrome (NAS). The researchers defined in utero exposure as “opioid use or a clinical diagnosis of neonatal abstinence syndrome for a child.”2
Lead author, Romuladus Azuine, DrPH, MPH, RN, at the Health Resources and Services Administration at the US Department of Health and Human Services, noted the wide-ranging effects of mother-child opioid use: “The federal government is making concerted efforts to identify risk factors and improve prevention strategies to reduce health effects of opioids. This is the first study to understand the consequences of maternal opioid use on physical health and developmental outcomes of children exposed to opioids using 20 years of clinical data.”
The effects of maternal opioid abuse can be found across the lifespan of their offspring: “Opioid exposure was associated with higher risks of fetal growth restriction and preterm birth. For preschool-aged children, we found that opioid exposure was associated with increased risks of lack of expected physiological development and conduct disorder/emotional disturbance. For school-aged children, opioid exposure was associated with a higher risk of ADHD,” Dr Azuine reported to Psychiatric Times.
Insights for psychiatrists
Although study authors do not make clinical recommendations per se, Dr Azuine notes that psychiatrists play a critical role in the screening, diagnosis, and treatment of substance use disorders and addiction. He also states that the findings have two key implications for psychiatrists.
âº Scope: The magnitude of poor health outcomes associated with in utero opioid exposure underscores the need for psychiatrists to look out for women at risk for opioid exposure. “The short- and long-term outcomes associated with opioid exposure are too dire to ignore . . . We must act now. All hands must be on deck, and psychiatrists can be the leaders on this.”
âº Screening and treatment: The consequences of opioid exposure cut across the life span of women and their children. “Screening and treatment for opioid use disorder should be delivered within the context of the life course identifying and treating women before they become pregnant, when they are pregnant, and after they have had their babies. Health care providers must use every window of opportunity to prevent the harm of opioid use and exposure among mothers and children.”
The implications of the study as it relates to psychiatric treatment are to continue to provide compassionate care within a safe environment. “We found that there were sociodemographic risk factors for opioid exposure. Psychiatrists should consider these social and environmental factors when they see pregnant mothers suspected with opioid use disorders.”
Future studies should consider other factors outside the scope of this research that found patients who abuse opioids may also gravitate to other drugs (eg, marijuana, stimulants, alcohol, tobacco). “This tells us that there is probably no single substance of addiction,” said Dr Azuine.
This article was originally posted on 7/9/19 and has since been updated.
Ms Martin is Senior Digital Managing Editor of Psychiatric Times. Twitter: @LaurieEMartin
1. Azuine RE, Ji Y, Chang HY, Kim Y, et al. Prenatal Risk Factors and Perinatal and Postnatal Outcomes Associated With Maternal Opioid Exposure in an Urban, Low-Income, Multiethnic US Population. JAMA Netw Open. 2019;2:e196405.
2. Birth, Child Outcomes Associated With Moms Using Opioids During Pregnancy. JAMA Network [press release]. June 28, 2019. https://media.jamanetwork.com/news-item/birth-child-outcomes-associated-with-moms-using-opioids-during-pregnancy. Accessed July 8, 2019.