An illustration of a pregnant woman in a serene environment, with subtle neural pathways flowing between her and a child, symbolizing the connection and developmental impact of opioid exposure. The setting features a soft, calming background, representing medical safety and caution.
The potential risks of prenatal opioid exposure have been a growing concern, particularly as opioid use has become more prevalent. This study aims to explore whether maternal opioid use increases the risk of neuropsychiatric disorders in children, based on a large cohort study conducted in South Korea.
Scope of the Study
The research analyzed data from over 3 million children born between 2010 and 2017 in South Korea. It specifically looked at those with prenatal opioid exposure compared to those without, to assess whether there was a measurable increase in the risk of developing neuropsychiatric disorders. The study also explored factors such as the timing, duration, and dosage of opioid use during pregnancy.
The authors explain that opioid exposure during pregnancy was associated with a modest increase in neuropsychiatric risks, particularly in cases where high doses were used or exposure occurred during the first trimester. However, they emphasize, “This increase in risk should not be considered clinically significant.” The researchers stress that while some association exists, it is minor and influenced by specific factors like dosage and timing.
Findings
Key findings include a slight risk increase in children whose mothers used opioids for more than 60 days or at high doses. Disorders such as attention deficit hyperactivity disorder (ADHD), mood disorders, and intellectual disability were more frequently observed among these children. However, in sibling comparison cohorts, where children from the same family were exposed differently, the results did not indicate a substantial difference, leading researchers to conclude that familial and genetic factors might play a larger role than opioid exposure itself.
Dr. Dong Keon Yon, one of the study’s lead authors, stated: “Our findings suggest that while there is an observable increase in neuropsychiatric disorders with opioid use, it is not clinically meaningful in most cases. Caution should be applied in opioid prescribing, especially in cases where high doses or prolonged use are necessary.”
Risk Factors and Considerations
The research also highlighted that the risk of neuropsychiatric disorders was more prevalent in certain conditions:
- When opioids were used during the first trimester.
- When multiple opioids were prescribed simultaneously.
- For long-term opioid use (60 days or more).
However, Dr. Jiseung Kang notes, “In most cases of opioid use, especially when usage is short-term or low-dose, the risk remains minimal.”
The researchers conclude that opioid use during pregnancy should be approached with caution but should not be overly restricted for necessary medical treatments. “Further research is needed,” Dr. Kang adds, “to refine guidelines on opioid prescribing during pregnancy to ensure the safety of both mothers and children.”
Implications for Clinical Practice
Despite the slight risks, the study strongly recommends that healthcare providers weigh the benefits of opioid use against the potential neuropsychiatric outcomes for the child. The current findings align with prior research, which also highlights that opioid exposure, particularly at low doses, does not pose a significant neuropsychiatric risk.
As Dr. Samuele Cortese explains, “We need to continue balancing the need for effective pain management with the potential risks. What this study tells us is that for most cases, opioids can be safely used in pregnancy, but prolonged use or high doses should be handled with care.”
Citation:
Kang J, Kim HJ, Kim T, et al. Prenatal opioid exposure and subsequent risk of neuropsychiatric disorders in children: nationwide birth cohort study in South Korea. BMJ. 2024;385. doi:10.1136/bmj-2023-077664.
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