Byline: Vikram. Vasan, Yuma. Kitase, Jessie. Newville, Shenandoah. Robinson, Gwendolyn. Gerner, V. Burton, Lauren. Jantzie
Substance use, specifically the use of prescription and non-prescription opioids among pregnant women, is a major public health issue and chief contributor to the opioid crisis. The prevalence of Neonatal Opioid Withdrawal Syndrome has risen 5-fold in the past decade, and is a well-recognized consequence of perinatal opioid exposure. By contrast, the long-term damage to the developing brain from opioid medications is just beginning to be recognized as a serious concern. Published data suggest that opioid exposure commencing in utero negatively affects the maturation of the neural-immune system, and trajectory of central nervous system development. Methadone induces peripheral immune hyper-reactivity, lasting structural and microstructural brain injury, and significant deficits in executive function and cognitive control in adult animals following in utero exposure. Thus, to address the cascading public health crisis stemming from the multitude of infants with in utero opioid exposure who will grow up with altered neurodevelopmental trajectories, rigorous preclinical, mechanistic studies are required. Such studies will define the long-term sequelae of prenatal opioid exposure in an effort to develop appropriate and targeted interventions. Specifically, the development of novel fluid, neuroimaging and biobehavioral biomarkers will be the most useful to aid in early identification and treatment of opioid exposed infants with the greatest risk of poor clinical outcomes. These studies will be essential to understand how in utero insults determine brain structure and function in adulthood, and what targeted interventions will be required to improve long-term outcomes in the countless children being born exposed to opioids each year.
In the United States, the opioid crisis poses a severe threat to present and future public health. The acute emergency is increasingly apparent, with more than 100 US citizens dying from opioid overdoses every day (Hedegaard et al., 2018). Though this national crisis has received attention and the number of deaths secondary to opioid overdose is alarming, the full depth and breadth of the opioid crisis, especially the impact on infants and children, is often overlooked. Indeed, maternal opioid use rates during pregnancy have more than quadrupled in the last decade. According to the Centers for Disease Control, from 2008-2012, approximately 1 in every 3 pregnant women filled an opioid prescription. Opioid use in pregnancy entails the use and misuse of prescription opioids, such as codeine, morphine, oxycodone, and illicit opioids, such as heroin, or medications used to treat opioid use disorder, such as methadone and buprenorphine.
Among the limited attention given to perinatal opioid exposure, research has focused on the immediate perinatal effect from maternal opioid use, described as Neonatal Opioid Withdrawal Syndrome (NOWS) (Honein et al., 2019). The incidence of NOWS has increased five-fold since 2000 from 1.19 per 1000 hospital births in the US to 5.63 in 2012, while the incidence of infants treated in the NICU has increased five-fold in the same time period (Sanlorenzo et al., 2019). Although NOWS is a well-recognized consequence of perinatal opioid exposure, the full life-long...