(118) School readiness among children exposed to opioids during pregnancy in Manitoba, Canada

Publication Number: 1113

Introduction:
Prescription opioid use has increased among pregnant women. However, there is inconsistent evidence on the long-term neurodevelopmental outcomes of children following opioid exposure during pregnancy. The aim of this study is to examine the association between prenatal opioid exposure and developmental vulnerability using Early Development Instrument (EDI) data. EDI is a well-validated 103-component kindergarten teacher-completed questionnaire, that encompasses five developmental domains.

Methods:
A cohort of mother-child dyads with children born in Manitoba, Canada between 2005 and 2011 was identified. Exposure group includes mothers who have filled at least two outpatient prescriptions for an opioid at any time during pregnancy. Each child in the exposure group was matched to up to 4 controls based on maternal age, gestational age, sex, kindergarten year, and income quintile. EDI was used to assess developmental health of the cohort. A logistic regression model was used to assess the association between prenatal opioid exposure and vulnerability in the EDI. The model adjusted for maternal mental health, maternal diabetes and children’s receipt of child protective services.

Results:
Of 67303 eligible children, 4787 were included, of whom 973 were in the exposed group and 3814 were in the control group. 34 % of the exposed group were developmentally vulnerable in 2 or more domains compared with 18 % of the control group (Adjusted Odds Ratio(AOR)= 1.34; 95% CI 1.12-1.60; p 0.001). Children in the exposed group had a significant higher likelihood of being vulnerable in physical health and well-being domain (AOR= 1.25; 95% CI 1.03-1.51; p 0.02), communication skills and general knowledge (AOR= 1.42; 95% CI 1.16-1.74; p 0.0006), language and cognitive development (AOR= 1.45; 95% CI 1.19-1.76; p 0.0002) and social competence (AOR= 1.54; 95% CI 1.27-1.87; p <.0001). However, opioid exposure was not significantly associated with vulnerability in the emotional maturity domain (AOR= 1.21; 95% CI (0.98-1.49); p 0.07). For secondary analysis, we assessed the relationship between timing of exposure, duration of exposure, cumulative opioid dose during gestation and developmental vulnerability.

Conclusion:
Prenatal opioid exposure was associated with an increased risk of developmental vulnerability in this matched cohort study. This suggests that children with prenatal opioid exposures and their families should be offered early and long-term developmental screening and family-centered support.