NEURODEVELOPMENTAL OUTCOMES OF CHILDREN BORN TO OPIOID-DEPENDENT MOTHERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

ABSTRACT Background Children born to opioid-dependent mothers are at risk of adverse neurodevelopment. The magnitude of this risk remains inconclusive. Objectives To conduct a meta-analysis of studies that assessed neurodevelopmental outcomes of children aged 0 to 12 years born to opioid-dependent mothers, compared with children born to non-opioid-dependent mothers, across general cognitive, language, motor, and social-emotional domains. Data Sources PubMed, CINAHL, PsycINFO, and Google Scholar databases. Study Eligibility Criteria English-language publications between January 1993 and November 2018, including prenatally opioid-exposed and non-opioid-exposed comparison children, reporting outcomes data on standardized assessments. Study Appraisal and Synthesis Methods Two reviewers independently extracted data. Pooled standardized mean differences (SMDs) were analyzed using random effects models. Risk of bias was assessed with the Newcastle-Ottawa Quality Assessment Scale. Results Across 16 studies, individual domain outcomes data were examined for between 93 to 430 opioid-exposed and 75 to 505 non-exposed infants/children. Opioid-exposed infants and children performed more poorly than non-exposed infants and children across all outcomes examined, demonstrated by lower infant cognitive (SMD=0.77) and psychomotor scores (SMD=0.52), lower general cognition/IQ (SMD=0.76) and language scores (SMD=0.65–0.74), and higher parent-rated internalizing (SMD=0.42), externalizing (SMD=0.66), and attention problems (SMD=0.72). Limitations Most studies examined early neurodevelopment; only three reported school-age outcomes thereby limiting the ability to assess longer-term impacts of prenatal opioid exposures. Conclusions and Implications of Findings Children born to opioid-dependent mothers are at modest- to high-risk of adverse neurodevelopment at least to middle childhood. Future studies should identify specific clinical and social factors underlying these challenges to improve outcomes.