TOPLINE

Prenatal opioid exposure (POE) through illicit opioids or medication for opioid use disorder (MOUD) was significantly associated with heightened risks for cognitive difficulties, hyperactivity, and visual impairments in school-aged children, a systematic review of 27 studies found.

METHODOLOGY

• Researchers systematically reviewed 27 quantitative articles evaluating outcomes in school-aged children after POE, with a search of key databases for articles published from 2015 to 2025.
• The study evaluated 31,104 children exposed to opioids and 5,430,272 control individuals from 10 countries, primarily in North America, Australasia, and Europe.
• Study designs were quantitative and included prospective birth cohort studies (n = 10), retrospective administrative data studies (n = 11), a combination of those two designs (n = 5), and one cross-sectional study.
• Exposures included illicit opioids, MOUD (methadone or buprenorphine), or a diagnosis of neonatal abstinence syndrome or neonatal opioid withdrawal syndrome.
• Outcome assessments focused on health, educational, and neurodevelopmental domains such as verbal IQ, memory deficits, hyperactivity, inattention, and attention-deficit/hyperactivity disorder (ADHD) diagnoses; visual acuity; strabismus and nystagmus; child removal; care placements away from birth parents; and attachment at ages of 5-18 years.

TAKEAWAY

• All four studies examining visual outcomes found associations with POE, with higher rates of strabismus (30.2% vs 4.8%) and nystagmus (15.9%-20.0% vs 0.0%-1.6%) in children with POE than in control individuals; exposure to methadone showed worse outcomes than exposure to buprenorphine.
• POE was linked to higher levels of hyperactivity/inattention, an increased risk for ADHD (hazard ratio [HR], 1.43), and a 37.1% out-of-home placement rate at ages of 6-8 years, with fewer attachment difficulties if staying with birth parents.
• Seven out of ten studies showed an association between POE and poorer cognitive functioning across various measures, including lower verbal IQ and increased rates of developmental delay (HR, 1.56) and intellectual disability (HR, 2.37).
• Children with POE demonstrated significantly higher rates of dental caries than control individuals (68.7% vs 27.0%), with POE associated with an increased risk for any caries (HR, 1.40) after adjusting for confounders.

IN PRACTICE

"Whilst it was not the aim of this review to establish causality, these findings suggest that vulnerabilities associated with POE may become more apparent with age, underscoring the importance of proportionate, non-stigmatising surveillance and early support to reduce cumulative disadvantage," the authors wrote.

SOURCE

The study was led by Louise Marryat, University of Glasgow, Glasgow, Scotland. It was published online on July 21, 2026, in Addiction.

LIMITATIONS

The study was limited by small sample sizes across individual articles; substantial longitudinal attrition; highly heterogeneous "exposure capture"; and the lack of data on the dosage, timing, duration, frequency, or route of exposure. It was further limited by the reliance on predictive modelling rather than causal inference techniques, inadequate control for competing exposures alongside overadjustment for causal pathway factors, and sparse data from the adolescent period.

DISCLOSURES

This research received funding through a UK Research and Innovation Future Leaders Fellowship. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.