After Birth, Opioids' Toll Continues

Updated: Nov 27, 2020

Previous research indicates that babies born with neonatal abstinence syndrome may face learning difficulties. (TIMOTHY D. EASLEY/AP)The children of the opioid crisis are likely to grapple with the consequences of early drug exposure beyond even their youngest years, a new study shows.

The prevalence of babies born with neonatal abstinence syndrome – in which an infant suffers withdrawal, often from opioids, as a result of the mother's drug use while pregnant – has soared since the early 2000s. And new research published by JAMA Network Open indicates opioid exposure is associated with substantially worse outcomes throughout childhood.

For the study, researchers analyzed about 8,500 mother-newborn pairs included in the Boston Birth Cohort, a separate longitudinal study sponsored by Johns Hopkins University that enrolled primarily urban and low-income participants who delivered at Boston Medical Center. About 3,150 children continued to receive treatment there until they turned 21.In all, 5.3% of babies were exposed to opioids in utero – with researchers noting an "upward trend" in neonatal abstinence syndrome over more than a decade of data.

"We are worried about the consequences of opioid exposure on children, as well as on the moms," says Romuladus Azuine, the study's lead author and a research division director in the federal Health Resources and Services Administration's Maternal and Child Health Bureau.Opioid-exposed babies were substantially more likely to be smaller than expected for the length of pregnancy and to be born preterm, the study found. Preschool-aged kids were more likely to lag behind developmentally, and were more likely to have behavioral or emotional problems. Children 6 and older, meanwhile, were more likely to be diagnosed with attention deficit hyperactivity disorder.

It's still unknown how these children will fare later in life, and Azuine says future studies should focus on their long-term outcomes.

"The opioid epidemic is not (only) an epidemic of the present – it is an epidemic of the future," Azuine says. "The consequences affect babies, children and the entire family. It is multigenerational."

Previous research indicates that babies born with neonatal abstinence syndrome may face learning difficulties and issues with motor development in the first few years of life, among other health concerns. But no national monitoring system exists to track these children, and state data collection has been patchwork, making it difficult to fully understand how women's opioid use affects their children in the long term.

The new study helps fill some of those gaps, and Azuine says the findings are especially troubling amid the heightened prevalence of neonatal abstinence syndrome. In 2012, at its peak, the NAS rate among the Boston Birth Cohort was 63.1 per 1,000 births. Recent national data suggests a much smaller share of infants – between 6.5 and 8 per 1,000 births – are born with the syndrome. Higher incidence among the Boston cohort may "underscore the potential disparities in NAS experienced by urban low-income populations living in the inner cities of the United States," the study says. The opioid crisis' death toll – with a rate that surged fivefold since 1999 – has generated thousands of headlines and billions of dollars in federal and state efforts to rein in the epidemic. But there's been a major gap in treatment and support for addicted women and their children, experts say.

"It's not only that you treat mom, or you treat the baby," Azuine says. Lisa Cleveland, a neonatal abstinence syndrome researcher and associate professor at the University of Texas Health Science Center at San Antonio, cautions against drawing a cause-and-effect relationship between the Boston mothers' opioid use and the poor outcomes of their children. Other factors – like genetics, maternal depression and prescription drug use – also may affect a child's development, she says, and low-income families additionally could be dealing with issues like food and housing insecurity, violence, or exposure to air pollution and other environmental toxins. "We know there is often a genetic or familial tendency with conditions such as ADHD, conduct disorders and emotional disturbance," Cleveland says. "Many times these undiagnosed and untreated conditions are what contributed to maternal drug use in the first place."

A separate analysis of a similar cohort of women who received opioid addiction treatment in recent years indicates 15% had unstable housing and about half had been incarcerated, while nearly 71% had hepatitis C. The majority of women had been sexually or physically abused.Azuine and his fellow authors said addressing the "root causes" of maternal drug use is key. Most mothers in the Boston cohort who used opioids used other substances – including marijuana and stimulants – indicating opioids are "only part of the problem," according to the study.

"We should be able to look at (mothers) more holistically," Azuine says. "In addition to opioids, what else might these moms be exposed to … and how could we use that information to begin to craft programs and policies that will address the opioid epidemic among women, children and families across the country?"

Gaby Galvin, Staff WriterGaby Galvin is a staff writer at U.S. News & World Report.


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