ArticleBMC pediatrics2026
Association between prenatal opioid exposure and long-term neurodevelopmental disorders among children: a nationwide cohort study : Prenatal opioid exposure and neurodevelopment.
Article in BMC pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundExisting evidence on the long-term effects of prenatal opioid exposure on child development remains inconsistent, often limited by short follow-up and insufficient control for maternal clinical indications. We investigated whether maternal opioid use during pregnancy is associated with an increased hazard of long-term neurodevelopmental disorders (LNDD) in children, utilizing an extended 13-year follow-up.
methodsThis retrospective, population-based cohort study used the National Health Insurance Service database in South Korea, including all live births between 2011 and 2014 (n = 1,553,505). Children were followed until December 31, 2023. Maternal opioid prescriptions were categorized by trimester and duration (1–6 days vs. ≥ 7 days). To address confounding by indication, propensity score (PS) matching (1:10 ratio) and multivariable Cox proportional hazards models were employed, adjusting for maternal psychiatric history and pain-related clinical indications.
resultsIn the matched cohort (n = 133,147), the incidence of LNDD was 10.53 per 1,000 person-years (PY) in the opioid-exposed group and 9.26 per 1,000 PY in the non-exposed group. Prenatal opioid exposure was associated with a 14% increased hazard of total LNDD (hazard ratio [HR] 1.14; 95% CI 1.08–1.20; P < 0.001). Subtype analysis showed the strongest association for intellectual disabilities (HR 1.33; 95% CI 1.16–1.53; P < 0.001). The hazard was more pronounced with first-trimester exposure (HR 1.17; 95% CI 1.06–1.28; P = 0.001) and longer durations of use (≥ 7 days: HR 1.17; 95% CI 1.09–1.24; P < 0.001).
conclusionsPrenatal opioid exposure is associated with a significantly increased hazard of LNDD, particularly intellectual disabilities, independently of maternal psychiatric and pain conditions. This hazard was particularly pronounced following first-trimester exposure and longer durations of use, with intellectual disabilities showing the strongest association. These findings, based on long-term follow-up into early adolescence, emphasize the need for cautious opioid prescribing during pregnancy and developmental surveillance for exposed offspring.
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