Prenatal Opioid Exposure and ADHD Childhood Symptoms: A Meta-Analysis.

Ashlyn N Schwartz,Laurie L Meschke,Lucia M Reyes,Kristina W Kintziger

doi:10.3390/children8020106

Ashlyn N Schwartz, Laurie L Meschke + Show 2 more

Open Access

https://doi.org/10.3390/children8020106

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Journal: Children	Publication Date: Feb 4, 2021
Citations: 17	License type: CC BY 4.0

Affiliation: University of Tennessee at Knoxville

Abstract

To systematically investigate the association between prenatal opioid exposure (POE) and attention-deficit hyperactivity disorder (ADHD) symptoms in children 2–18 years old, studies were searched using PubMed, CINAHL, PsycINFO, and Web of Science from January of 1950 to October of 2019. Inclusion criteria were observational studies reporting ADHD symptoms of children with POE compared with non-exposed children or normative data. The study protocol was registered with PROSPERO: CRD42018115967. Two independent reviewers extracted data on hyperactivity/impulsivity, inattention symptoms, ADHD combined subscale symptoms, and sample characteristics. Of 223 articles screened, seven met the inclusion criteria. Data represent 319 children with POE and 1308 non-exposed children from 4.3 to 11.2 mean years from five countries. POE was positively associated with childhood hyperactivity/impulsivity (d = 1.40; 95% CI, 0.49–2.31; p = 0.003), inattention (d = 1.35; 95% CI, 0.69–2.01; p < 0.0001), and combined ADHD symptoms scores (d = 1.27; 95% CI = 0.79–1.75; p < 0.0001). POE was positively associated with ADHD combined symptom scores at preschool (d = 0.83, 95% CI, 0.57, 1.09; p < 0.0001) and school age (d = 1.45, 95% CI, 0.85 to 2.04; p < 0.0001). Results suggest increased risk of ADHD symptoms during school age. Future research is needed to clarify the relationship between biological, social, and environmental risk and ADHD symptoms for children who experienced POE.

Highlights

Opioid use amongst reproductive-age women is increasing globally [1,2] and has been associated with infant risk, including neonatal abstinence syndrome (NAS) [3,4,5,6], low birth weight [7], preterm birth [8], and altered neonatal brain development [9]
In alignment with our hypothesis, findings of this meta-analysis indicated that children with prenatal opioid exposure (POE) have higher hyperactivity/impulsivity, inattention, and combined attention-deficit hyperactivity disorder (ADHD) symptoms compared to non-exposed controls
While results of our analyses suggest that ADHD symptoms in children with POE may increase as children age, there are a number of considerations

Summary

Introduction

Opioid use amongst reproductive-age women is increasing globally [1,2] and has been associated with infant risk, including neonatal abstinence syndrome (NAS) [3,4,5,6], low birth weight [7], preterm birth [8], and altered neonatal brain development [9]. Children with prenatal opioid exposure (POE) face disproportionate risks. A meta-analysis of five studies of POE children’s neurobehavior by Baldacchino and colleagues found significant impairments for cognitive, psychomotor, and behavioral outcomes compared to non-exposed controls in infant and preschool children [13]. In a meta-analysis by Monnelly and colleagues, six of seven studies found that children with POE had increased behavioral problems compared to non-exposed controls of children less than 2 years [14]. Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, 2–3 outcomes, and study design (PICOS)

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Discussion

Conclusion