Study suggests children being let down by knowledge gaps around opioids
Based on the results of her and her team’s most recent study, she said there is an “urgent need for greater knowledge of how exposure to substances such as fentanyl, heroin, and a multitude of prescription painkillers in the womb impacts the health and development of children.”
Dr Marryat said studies suggest roughly 1 in 100 children in Scotland are affected by opioid use in pregnancy. That is approximately the same rate as the Scottish children who have autism, according to NHS data.
Crucially, however, there is a lack of scientific research into children who were exposed to opioids in the womb. As a result, little is known about the direct links between specific cognitive and physical symptoms in early childhood and exposure.
Dr Marryat has said that better studies of children’s environments and development can provide clearer answers, helping to make medicine more efficient and supporting children during their development.
However, she said more information is needed to do that, and this means better access to and understanding of vulnerable children and families.
“We need to provide healthcare providers, government, and parents with the information that is needed to ensure that countless numbers of children receive the information and support they deserve.”
Dy Marryat and the Dundee team’s study analysed 478 papers dealing with exposure to opioids in the womb and resulting childhood impacts. As an umbrella study, the goal was to combine existing data to identify potential links between opioid use during pregnancy and developmental difficulties in children.
The team found potential links to specific physical impairments in visual development and motor skills, and also that children exposed to opioids in the womb were at increased risk of behavioural problems and language difficulties.
But Dr Marryat said the fundamental importance of her team’s findings may be in the gaps they uncovered. The umbrella study focused on children from birth until preschool age.
In the report’s findings, the team argued that longer-term studies of affected children are the only reliable evidence for informing medical practice and government policy.
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Without larger sample sizes and access to children as they continue to develop later in their lives, she said, it can be impossible to know for sure whether the linked difficulties are a direct result of opioid exposure or a combination of other complex environmental factors.
“If you’re having behavioural difficulties with children, we do not know if that’s because they have been exposed to opioids in pregnancy which has made changes in the way their brain has developed, or whether it is because of the environment that they are living in and what has happened to them since birth.
“It might be in part that it’s just a bit too early to measure some of these signs.”
Closing these gaps can mean better protection for pregnant mothers and their children and better interventions for exposed children later in life. One reason more research on the effects of opioids during pregnancy can prove beneficial is that a majority of mothers who use these substances while pregnant are using prescription drugs, such as methadone.
She said a better understanding of the long-term impacts can allow healthcare providers to make better-informed decisions about how to support pregnant mothers.
“Women who use opioids in pregnancy overwhelmingly want the best for their child. During pregnancy, the focus for mothers is very much on having a healthy baby. These are fundamental and understandable concerns but focus less on the long-term outcomes of the child, even when exposed to opioids.”
However, Dr Maryatt said that researchers and healthcare providers need families to feel comfortable coming forward and engaging with the system in order to close these gaps.
However, she said this brings its own challenges.
“I think we have really good universal services. We have a really strong tradition of health visiting, but I think it’s really under-resourced.
“For these families impacted by opioid use, it can be particularly tricky to engage in services. First, because they are often stigmatised by the services that are meant to help them, and the parents who have used drugs have experienced lots of stigma.
“Many fear that their children may be removed from their care. There needs to be appropriate pathways providing services that work alongside parents to fully support children and families in challenges they might face, but that is not easy when many services are already stretched.
“We need to be in a position to give people the information that they need to make decisions for themselves, to make informed decisions, but also to make sure that we do not increase the stigma as well around substance use.”
