Prenatal opioid exposure is associated with a significantly higher risk for subsequent attention-deficit/hyperactivity disorder (ADHD) and carries a higher risk than exposure to other substances, according to a study published in JAMA Network Open.
Henri M. Garrison-Desany, from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues estimated the aggregate burden of polysubstance exposure during gestation. They also assessed the consequences of using specific substances during this vulnerable time, with a particular focus on the risk for childhood ADHD. The analysis included data from 3,138 children participating in the Boston Birth Cohort (1998 to 2019), with a median follow-up of 10 years.
The researchers found that 24.2 percent of women reported using at least one substance while with child, with tobacco being the most frequently reported (18.5 percent). In addition, gestational opioid exposure (60 children) had the highest risk for future ADHD (adjusted hazard ratio [HR], 2.19), which was somewhat lessened after accounting for the effects of all individual substances in an elastic net regression model (HR of opioids, 1.60).
There was evidence of a statistical interaction between opioids and both cannabis and alcohol on ADHD risk (HRs, 1.42 and 1.15, respectively). An interaction was also noted between opioids and smoking and a higher risk for ADHD (HR, 1.17).
“The findings of this study suggest that it is important to consider prenatal concurrent exposure to multiple substances and their possible interactions when counseling women regarding substance use and [having a child], the future risk of ADHD for their children, and strategies for cessation and treatment programs,” the authors write.
