Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study

Andi Camden; Teresa To; Tara Gomes; Joel Ray; Li Bai; Astrid Guttmann

doi:10.1136/archdischild-2022-325029

Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study

Arch Dis Child. 2023 Sep;108(9):754-761. doi: 10.1136/archdischild-2022-325029. Epub 2023 Jun 12.

Authors

Andi Camden^{1

2

3}, Teresa To^{1

2

3}, Tara Gomes^{2

4

5}, Joel Ray^{2

6

7}, Li Bai², Astrid Guttmann^{8

2

3

9

10}

Affiliations

¹ Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada.
² ICES, Toronto, Ontario, Canada.
³ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁵ Department of Paediatrics, and Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada.
⁶ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
⁷ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
⁸ Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada astrid.guttmann@ices.on.ca astrid.guttmann@ices.on.ca.
⁹ Department of Obstetrics and Gynaecology, St. Michaels Hospital, Toronto, Ontario, Canada.
¹⁰ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Abstract

Objectives: To quantify well-child visits by age 2 years and developmental screening at the 18-month enhanced well-child visit among children with prenatal opioid exposure (POE) and to identify factors associated with study outcomes.

Design: Population-based cohort study.

Setting: Ontario, Canada.

Participants: 22 276 children with POE born 2014-2018 were classified as (1) 1-29 days of prescribed opioid analgesia, (2) 30+ days of prescribed opioid analgesia, (3) medication for opioid use disorder (MOUD), (4) MOUD and opioid analgesia, or (5) unregulated opioids.

Main outcome measures: Attending ≥5 well-child visits by age 2 years and the 18-month enhanced well-child visit. Modified Poisson regression was used to examine factors associated with outcomes.

Results: Children with POE to 1-29 days of analgesics were most likely to attend ≥5 well-child visits (61.2%). Compared with these children, adjusted relative risks (aRRs) for ≥5 well-child visits were lower among those exposed to 30+ days of opioid analgesics (0.95, 95% CI 0.91 to 0.99), MOUD (0.83, 95% CI 0.79 to 0.88), MOUD and opioid analgesics (0.78 95% CI 0.68 to 0.90) and unregulated opioids (0.89, 95% CI 0.83 to 0.95). Relative to children with POE to 1-29 days of analgesics (58.5%), respective aRRs for the 18-month enhanced well-child visit were 0.92 (95% CI 0.88 to 0.96), 0.76 (95% CI 0.72 to 0.81), 0.76 (95% CI 0.66 to 0.87) and 0.82 (95% CI 0.76 to 0.88). Having a regular primary care provider was positively associated with study outcomes; socioeconomic disadvantage, rurality and maternal mental health were negatively associated.

Conclusion: Well-child visits are low in children following POE, especially among offspring of mothers receiving MOUD or unregulated opioids. Strategies to improve attendance will be important for child outcomes.

Keywords: Child Development; Epidemiology; Healthcare Disparities; Paediatrics; Primary Health Care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Analgesics / therapeutic use
Analgesics, Opioid* / adverse effects
Child
Child Care
Child, Preschool
Cohort Studies
Female
Humans
Ontario / epidemiology
Opioid-Related Disorders* / drug therapy
Pregnancy

Substances

Analgesics, Opioid
Analgesics

Grants and funding

CIHR/Canada