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Opioid use in pregnancy linked to childhood illness
According to new research, women who used opioids during pregnancy are more likely to have children with infections, eczema and asthma later in life.
Prenatal opioid exposure may have long-term health consequences for children.
While opioid use in pregnancy has long been associated with poor health outcomes for mothers and their babies, less is understood about the long-term health consequences of opioid exposure – particularly for affected children.
However, new research now suggests that children exposed to opioids in the prenatal period are more likely to experience certain immune-related conditions later in childhood.
In the retrospective study published in JAMA, the researchers analysed data from all children born in Western Australia between 2013 and 2018, which included more than 400,000 live births.
Dispensing data for Schedule 8 medications prescribed for various indications, such as pain management or opioid use disorder, were also examined. This included methadone, buprenorphine, oxycodone, fentanyl, morphine, tapentadol, pethidine, hydromorphine and high-dose codeine.
According to hospital and emergency department presentations from the study cohort, children with prenatal opioid exposure were more likely to be diagnosed with infection, eczema and asthma in their first five years of life.
Reassuringly, no increased risk of developing allergies, anaphylaxis or autoimmune disease was found.
‘Opioids play a critical role in fetal development,’ the authors wrote.
‘The use of exogenous opioids during pregnancy has the potential to interfere with these finely regulated physiologic processes, affecting a wide range of body systems, including the immune system.’
Lead researcher Dr Erin Kelty from the University of Western Australia told newsGP that understanding the potential impact of prenatal opioid exposure on immune-related conditions is ‘just a small part of the big picture’.
‘Prenatal opioid exposure could impact health beyond the neonatal period in ways which might not be obvious,’ she said.
According to another Australian study, the prevalence of opioid use in women of reproductive age was around 11% in 2020, down from nearly 13% in 2013. The most commonly prescribed opioids were codeine, oxycodone and tramadol, with prescriptions generally for short-term use only.
‘Opioids are used in pregnancy to treat serious maternal health issues, which if left untreated can have serious maternal and neonatal health consequences,’ Dr Kelty said, adding that more research is needed to better understand the role of different opioids in pregnancy.
‘We are really interested to see if there are substantial differences between individual opioid medications and if cessation during pregnancy is associated with better outcomes.’
The research had several limitations. As an observational study the findings are unable to support a causal relationship between opioid exposure and poorer child health outcomes. Additionally, the data included did not capture lower schedule opioid medications, such as low-dose codeine and tramadol, or opioids obtained without prescription.
Likewise, diagnosis rates were exclusively obtained from hospital datasets, meaning that immune-related conditions diagnosed in the community setting, such as primary care, were not included.
Drug safety information during pregnancy can be accessed via the Therapeutic Goods Administration’s Prescribing medicines in pregnancy database and GPs can consult with pregnancy and antenatal clinics at their local hospital if additional support is needed.
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