Robertson Senga, Hughes Thomas, Boardman James, McFadden Alison, Whittaker Anne, Marryat Louise
School of Health Sciences, University of Dundee, Dundee, UK.
The University of Edinburgh, Edinburgh, UK.
BMJ Paediatr Open. 2025 Jan 9;9(1):e003058. doi: 10.1136/bmjpo-2024-003058.
Early child development sets the course for optimal outcomes across life. Increasing numbers of children worldwide are exposed to opioids in pregnancy and frequently live in environments associated with adverse developmental outcomes. Although multiple systematic reviews have been published in this area, they use different exposures and different types of outcomes. This umbrella review aims to bring together these systematic reviews to provide a comprehensive overview of the evidence around the association between prenatal opioid exposure and preschool developmental outcomes.
PubMed, MedLine, PsycInfo and Google Scholar were searched up to July 2024. Eligible studies were systematic reviews, meta-analyses or scoping reviews exploring prenatal opioid exposure (illicit opioids and prescribed treatments for opioid dependence) and developmental outcomes up to age 5. Reviews were screened by two authors. Quality assessment was undertaken using the Joanna Briggs Institute checklist for umbrella reviews. Degree of overlap was examined. Due to heterogeneity within the sample, no meta-analyses were undertaken and results were synthesised narratively.
11 reviews were included containing 478 individual papers. The overlap was slight (corrected cover area=5%). Developmental outcomes associated with prenatal opioid exposure included visual function, motor skills, externalising problems and language difficulties. No conclusive evidence was available for cognitive development or internalising symptoms. In cognitive, and motor, skills, findings differed by age, with later preschool findings being weaker. Authors frequently highlighted issues with poor quality research in the original studies, including small sample sizes and lack of controlling for confounding.
Multiple areas of child development were associated with prenatal opioid exposure; however, evidence was weak. Robust research, with larger sample sizes and adequate accounting for confounding, is needed to provide accurate information for women of childbearing age and practitioners to guide policy and ensure that appropriate funding, support and follow-up are in place.
CRD42022307992.
儿童早期发展为一生的最佳结果奠定了基础。全球越来越多的儿童在孕期接触阿片类药物，并且经常生活在与不良发育结果相关的环境中。尽管该领域已发表了多项系统评价，但它们采用了不同的暴露因素和不同类型的结果。本伞状评价旨在汇集这些系统评价，以全面概述产前阿片类药物暴露与学龄前儿童发育结果之间关联的证据。
检索截至2024年7月的PubMed、MedLine、PsycInfo和谷歌学术。纳入的合格研究为探索产前阿片类药物暴露（非法阿片类药物和阿片类药物依赖的处方治疗）以及5岁以下儿童发育结果的系统评价、荟萃分析或范围综述。由两位作者对综述进行筛选。使用乔安娜·布里格斯研究所伞状评价清单进行质量评估。检查重叠程度。由于样本内存在异质性，未进行荟萃分析，而是对结果进行了叙述性综合。
纳入了11篇综述，包含478篇独立论文。重叠程度轻微（校正覆盖面积=5%）。与产前阿片类药物暴露相关的发育结果包括视觉功能、运动技能、外化问题和语言困难。关于认知发展或内化症状，没有确凿证据。在认知和运动技能方面，研究结果因年龄而异，学龄前后期的结果较弱。作者们经常强调原始研究中存在质量差的问题，包括样本量小和缺乏对混杂因素的控制。
儿童发育的多个领域与产前阿片类药物暴露相关；然而，证据薄弱。需要开展样本量更大且充分考虑混杂因素的有力研究，为育龄妇女和从业者提供准确信息，以指导政策制定，并确保有适当的资金、支持和随访措施到位。
PROSPERO注册号：CRD42022307992。
