Faculty of Graduate Studies (Electronic Theses and Practica)

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Browsing Faculty of Graduate Studies (Electronic Theses and Practica) by Subject ""Neonatal Opioid Withdrawal Syndrome""

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    The safety and long-term outcomes of opioid exposures in pregnancy
    (2025-01-28) Abulannaz, Omaymah; Ruth, Chelsea (Pediatrics and Child Health); Hatch, Grant (Pharmacology and Therapeutics); Hirani, Shela (University of Regina); Kelly, Lauren; 't Jong, Geert
    Background: The use of opioids during pregnancy has increased in North America. Opioids can cross the placenta and produce signs of withdrawal known as Neonatal Abstinence Syndrome (NAS). In this project, I described the trends of opioid prescriptions among pregnant people and the incidence of NAS in Manitoba, examined factors associated with the development and severity of NAS and investigated the neurodevelopmental outcomes following exposure to prescription opioids during pregnancy. Methods: A population-based cohort study was conducted using the population data repository of the Manitoba Center for Health Policy. Poisson regression models were used to describe the time trends of opioid prescriptions utilization during pregnancy and describe the incidence of NAS (Chapter 2). Multivariable logistic regression models were used to examine factors associated with the development and severity of NAS (Chapter 3) and to investigate neurodevelopmental outcomes following exposure to prescription opioids during pregnancy (Chapter 4). Early Development Instrument (EDI) was used to assess developmental vulnerability in kindergarteners. Results: The proportion of live births exposed to opioid prescriptions during pregnancy increased from 3.7% in 1995 to 7.4% in 2017; however, there has been a reduction in recent years. The incidence of NAS in Manitoba more than tripled between 1995 and 2021 (2.0-7.6 per 1,000 live births). Female sex, normal birth weight, and breastfeeding were protective factors against the diagnosis of NAS. Breastfeeding initiation was the only protective factor against the need for pharmacological treatment. Of the 103,905 eligible children, 51% of the exposed group (n=973) were developmentally vulnerable in 1 or more domains, compared with 32% of the matched control group (n=3,814) (Adjusted Odds Ratio [AOR] 1.46; 95% CI 1.23-1.71). Children in the exposed group had a significantly higher likelihood of being vulnerable in all domains: physical health and well-being (AOR 1.31; 95%CI 1.08-1.59), communication skills and general knowledge (AOR 1.53;95%CI 1.25-1.88), language and cognitive development (AOR 1.53;95%CI 1.25-1.86), social competence (AOR 1.60;95%CI 1.32-1.95); emotional maturity domain was the least affected (AOR 1.25;95%CI 1.01-1.55). There was a higher risk of developmental vulnerability in children exposed to opioids in early pregnancy, longer durations, and higher opioid doses. Conclusions: Prenatal exposure to opioids is increasing in Manitoba and was associated with an increased risk of developmental vulnerability in children. It is of utmost importance to provide children with POE and their families with early and long-term developmental screening and family centered supports to help achieve optimal educational and family health outcomes.