(223) Prenatal Opioid Exposure and Well-Child Care in The First 2 Years of Life - A Population-Based Cohort Study

Publication Number: 554

Background: Children may experience developmental issues following prenatal opioid exposure (POE). Whether well-child care (WCC) visits vary by type of POE and important social determinants of health is unknown.

Methods: In this population-based cohort study in Ontario, Canada, children with POE were classified as 1) <30 days prescribed opioid analgesia, 2) 30+ days prescribed opioid analgesia, 3) medication for opioid use disorder (MOUD [buprenorphine, methadone, or other opioid agonist]), 4) combined MOUD and opioid analgesia, or 5) unregulated opioid use. Study outcomes included attending ≥5 WCC visits by age 2 years, and the 18-month enhanced well-child visit (EWCV). Modified Poisson regression was used to examine factors associated with outcomes.

Results: Children with prenatal exposure to <30 days of opioid analgesics were most likely to attend ≥5 WCC visits (61.2%). Compared with these children, adjusted relative risks (aRR) for ≥5 WCC visits were lower among those exposed to 30+ days of opioid analgesics (0.95; 95% CI, 0.91-0.99), MOUD (0.83; 95% CI, 0.79-0.88), MOUD and opioid analgesics (0.78; 95% CI, 0.68-0.90) and unregulated opioids (0.89; 95% CI, 0.83-0.95). Relative to children with prenatal exposure to <30 days of opioid analgesics (58.5%), respective aRR for the 18-month EWCV were 0.92 (0.88-0.96), 0.76 (0.72-0.81), 0.76 (0.66-0.87) and 0.82 (0.76-0.88). Having a regular primary care provider was positively associated with study outcomes, whereas socio-economic disadvantage, rural residence and maternal mental health were negative associations.

Conclusions: WCC visits and EWCV are low in children following POE, especially among offspring of mothers receiving MOUD or unregulated opioids. Strategies to improve attendance will be important for child outcomes.