New research reassures the use of opioids during pregnancy and child development

The study of the University of Indiana introduces a new perspective of the growing collection of evidence suggesting that mild to moderate use of prescribed opioid painkillers during pregnancy does not cause an increased risk of autism spectrum disorder (ASD) or attention deficit/ hypeaktical disorder (ADHD) in children.

The examination studies documented connections between prescribed opioid painkillers during pregnancy and an increased risk of two neurodevelopmental disorders. It concludes that other factors, not the risk of the fetus to opioid painkillers, may explain the increased risk of autism and ADHD in children who have received opioid prescriptions during pregnancy.

This study “helps to provide more information to pregnant people and their doctors who try to make complex decisions about how best to deal with pain during pregnancy,” said the first author of Emma Cleary, a graduate in the laboratory jointly researcher of the study, Professor Brian d’Onofrio in the psychological and cerebral sciences department.

Although they are not able to exclude a slight increased risk for autism and ADHD with a large exposure, which were rare in our data, the results suggest that there is no causal effect of prescribed opioid painkillers on the risk of these two popular neurosal disorders. “

Emma Cleary, study first author and graduate student, Indiana University

The studies of the study also suggest that co-author of Ayesha Sujan, a post-coat employee at the Stanford University School of Medicine, “observed connections between prenatal exposure to opioid painkillers and two main neurosal disorders-auto-authe opioid analgesia.

Study data and projects

The study recalled extensive data from Swedish population registers, including over 1.2 million births in Sweden in 2007–2018, during ASD risk analysis, among which 4.4% were exposed to prescribed opioid drugs during pregnancy. ADHD risk analysis covered over 900,000 births in 2007–2015.

Scientists estimated the risk based on the dose range and duration of cumulative exposure during pregnancy. Analyzing data from various perspectives, the study also constituted a number of possible disturbing factors. Comparing children exposed to opioid drugs with unleashed children, the results suggest an increased risk with higher doses, as in previous studies.

However, when they statistically adapted to factors such as parental age and psychiatric conditions, and used a narrower set of comparative groups to take into account the common features between groups, the observed risk decreased. In particular, comparing exposed children with non -illuminated children whose parent was prescribed opioids a year before the concept, but not during pregnancy, the increased risk of autism and ADHD in exposed children was significantly reduced.

Similarly, the risk of these neurode development conditions disappeared when comparing the differential exposed siblings. These projects are a strong test of causal effects of these drugs, because they enabled researchers to maintain permanent some common features of prescribed opioids during pregnancy as well as genetic and environmental factors common to siblings.

The study entitled “Recorded opioid analgesic application during pregnancy and the risk of neurode development disorders in children: retrospective examination in Sweden” was published on September 16 in the journal.

As Cleary explained: “The way in which we take our arrangements together, it is that yes, we initially observe this increased risk of high dose and low doses. But when we increase our adaptation to various sources of potential prejudice, adaptation to the proxi of socio-economic status, history of mental health of parents parents, pregnancy features, we are able, we are able to diagnose, diagnosis, diagnosis. painful conditions, opioid.

Cleary added: “And when you do this, the risk that we initially observe, disappears. How previous tests were examined, these background features would make you both exposed to prescribed opioids and increase the risk of ASD and ADHD.”

One of the innovative features of the study was the use of text extraction algorithms, a new technique previously used by some authors to study the use of ADHD drugs, but not yet used for the prescribed use of opioids. This technique enabled researchers to take into account written instructions on each prescription, and thus consider possible differences in the way patients actually took medicine.

“In the case of these dispensations based on pharmacy,” Cleary said, “there is always some uncertainty, but in the case of extracting the text” if necessary “or prescriptions with a range, for example 1-3 tablets a day, we were able to test various possible versions of the exhibition-in these analyzes we found converting results.”

The study also included work in several areas and disciplines. As D’Onofrio added: “This is a great example of how cooperation among researchers, clinicians and data engineers can use large data sets to help answer key clinical questions, especially when it is not possible to conduct randomized controlled research.”

Take -out and future directions

Discoveries ultimately ensure greater clarity to people who want to treat pain during pregnancy, if they suggest that opioid painkillers do not cause a significantly increased risk of autism and ADHD. However, the findings also begging the question: what basic reasons for the increased risk of autism and ADHD in this group of children and how can they be solved?

“We need more explanations,” said Cleary. “It can be pain and the underlying pathophysiological processes can be genetics. But people who may be more exposed to opioid prescribing may also need more support to help deal with symptoms throughout pregnancy.”

Further research is needed to clarify the operation of these factors. And yet, as the co -author of Sujan added to her: “The results explain the critical need to provide pregnant people experiencing pain thanks to psychosocial support and tools based on pain to treat pain, both pharmaceutical and non -farmaceutical.”