Abstract
AimTo combine meta-analyses of multiple long-term outcomes in children prenatally exposed to methadone or buprenorphine through their mothers' Opioid maintenance therapy (OMT) with a systematic review of similar outcomes in experimental animals. MethodThe Medline, Embase, Web of Science, CINAHL, Cochrane and Epistemonikos databases were searched through August 30, 2018. Clinical studies measuring effects on cognitive, behavioral or visual outcomes in 3 months or older children prenatally exposed to OMT and control group(s) were included for meta-analyses. Experimental animal studies with similar exposures and outcomes were included in a systematic review. The three authors independently performed abstract screenings and full-text reviews, and extracted the data. One author performed the meta-analyses. ResultsThe pooled results of the meta-analyses showed worse cognitive, psychomotor, behavioral, attentional and executive functioning, and affected vision in children born to mothers who were in OMT during pregnancy compared to children without prenatal drug exposure (overall effect size = 0.49, 95% confidence interval = 0.38, 0.59, p < 0.00001). Many of the experimental animal studies showed impaired outcomes after prenatal exposure to methadone or buprenorphine. The clinical results may be biased, e.g., with the OMT group having more concurrent risk factors than the unexposed comparison group. There are few studies of older children. ConclusionChildren born to mothers in OMT show worse outcomes for a number of different behaviors and impaired vision compared to children born to nonusers. Experimental animal studies indicate that there might be a causal relationship between prenatal methadone or buprenorphine exposure and subsequent negative outcomes.
Highlights
Opioid maintenance therapy (OMT) is the recommended treatment for opioid addiction, including for pregnant women [1], as considerable benefits are seen for the mother [2]
A multitude of review articles regarding outcomes among children prenatally exposed to opioids or born with neonatal abstinences has been published [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26], but most of this work has concentrated on maternal treatment or intrauterine and neonatal effects [9,11,12,13,18,19,21,22] or has used unstructured or nonreplicable methods [5,6,8,10,15,16,17,20]
To provide information about the challenges OMT exposed children might experience and about the possible causal role of prenatal methadone or buprenorphine exposure for subsequent effects, the present study includes both meta-analyses of long-term outcomes in children born to mothers in OMT and a systematic review of relevant experimental animal data
Summary
Opioid maintenance therapy (OMT) is the recommended treatment for opioid addiction, including for pregnant women [1], as considerable benefits are seen for the mother [2]. A multitude of review articles regarding outcomes among children prenatally exposed to opioids or born with neonatal abstinences has been published [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26], but most of this work has concentrated on maternal treatment or intrauterine and neonatal effects [9,11,12,13,18,19,21,22] or has used unstructured or nonreplicable methods [5,6,8,10,15,16,17,20]. Of the five meta-analytical studies published in this field, one has focused on differences in short-term outcomes after methadone
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