Does opioid replacement therapy for infants with prenatal opioid exposure modify the risk of ADHD in childhood? A matched cohort analysis.
Source: PubMed, NCBI / U.S. National Library of Medicine
Prenatal opioid exposure (POE) in infants has been associated with increased risk for attention-deficit/hyperactivity disorder (ADHD). Does opioid replacement therapy (ORT) in infants after delivery amplify adverse impact of POE? If so, this should inform clinical decision-making about ORT. Assess how ORT modifies effects of POE on ADHD risk. Matched cohort study in a birth cohort (2010-2019). Each POE child is matched to 5 unexposed controls, balancing covariates within ORT and non-ORT POE subgroups. A large integrated Northern California health system. Child/mother dyads with children born at 35 weeks or later without congenital anomalies. POE was determined by dispensed opioid prescriptions from pharmacy records, urine drug screens, and chart review. ORT was determined using electronic administration records. ADHD, defined as the combination of an ICD-9/ICD-10 diagnosis code and two dispenses of ADHD medication. Overall ADHD incidence was 1.0% (median event age 7 years, median follow-up time 5.9 years). 280 matched sets comparing infants with ORT to matched controls (without POE) exhibited a 0.1% risk difference for ADHD. 2986 matched sets comparing infants with POE but not ORT to matched controls exhibited a 0.7% risk difference. The difference between these effects was not significant (95% confidence interval: -1.9%,0.8%). Our analysis reveals no evidence that ORT modifies detrimental impacts of POE on ADHD susceptibility, although short follow-up times limited outcome a
Abstract
Prenatal opioid exposure (POE) in infants has been associated with increased risk for attention-deficit/hyperactivity disorder (ADHD). Does opioid replacement therapy (ORT) in infants after delivery amplify adverse impact of POE? If so, this should inform clinical decision-making about ORT. Assess how ORT modifies effects of POE on ADHD risk. Matched cohort study in a birth cohort (2010-2019). Each POE child is matched to 5 unexposed controls, balancing covariates within ORT and non-ORT POE subgroups. A large integrated Northern California health system. Child/mother dyads with children born at 35 weeks or later without congenital anomalies. POE was determined by dispensed opioid prescriptions from pharmacy records, urine drug screens, and chart review. ORT was determined using electronic administration records. ADHD, defined as the combination of an ICD-9/ICD-10 diagnosis code and two dispenses of ADHD medication. Overall ADHD incidence was 1.0% (median event age 7 years, median follow-up time 5.9 years). 280 matched sets comparing infants with ORT to matched controls (without POE) exhibited a 0.1% risk difference for ADHD. 2986 matched sets comparing infants with POE but not ORT to matched controls exhibited a 0.7% risk difference. The difference between these effects was not significant (95% confidence interval: -1.9%,0.8%). Our analysis reveals no evidence that ORT modifies detrimental impacts of POE on ADHD susceptibility, although short follow-up times limited outcome ascertainment. These findings suggested cautious optimism in response to concerns about whether ORT may exacerbate effects of POE.