Hospitalisation of children after prenatal exposure to Methadone and Buprenorphine: national registry study from Czechia

Background

WHO recommends Opioid Maintenance Treatment (OMT) in pregnant women despite insufficient evidence for long-term effects of OMT to the children.

Aims

The aim of our study was to explore morbidity in children prenatally exposed to OMT compared to children born to mothers using OMT before pregnancy but not during pregnancy and mothers who had indications of opioid misuse but who were not in OMT. Additionally, OMT exposed children were compared to children born in the general population of pregnant women.

Design

Nation-wide register-based cohort study using personalized IDs assigned to all citizens for data linkage.

Setting

The Czech Republic (2000-14).

Participants

Children: (1) of mothers in OMT during pregnancy (n=218), (2) of OMT discontinuers (n=55), (3) of illicit opioid users (n=85) and (4) born to women without documented opioid abuse (GP) (n=1 238 452).

Measurements

We linked data from nationwide registries on reproductive health, addiction treatment, hospitalization and death. Information on all in-patient contacts, length of stay, and primary and secondary diagnosis were assessed. Diagnosis was classified according to the 10th revision of International Classification of Diseases (ICD-10). We performed binary logistic regression to explore the associations between OMT exposure and outcomes.

Findings

No differences were found in the overall proportion of children hospitalised between the OMT exposed, OMT discontinuers and illicit drugs opioid users groups (54.1%, 47.3%, 51.8%), while the proportion of hospitalised children from general population was significantly lower (35.8%). There were no significant differences in risk of specific diagnoses between OMT, OMT discontinuers and illicit drugs opioid user groups.

In adjusted analysis, differences between OMT and GP were still present when looking at infection and parasitic diseases (OR=2.0; 95% Confidence Interval 1.4-2.7); disease of digestive system (OR=1.7; 1.2-2.6), and disease of the skin and subcutaneous tissue (OR=1.9; 1.2-3.2).

Conclusion

Based on nationwide data, this study suggests that children prenatally exposed to opioids suffer from higher somatic morbidity during the first three years of life. Role of sociodemographic and lifestyle characteristic should be taken into account.