69 - Prenatal opioid exposure is associated with cognitive outcomes at 12 months of age after adjustment for covariates

Publication Number: 1062.69

Stephanie L. Merhar, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Sara DeMauro, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Nicole Mack, RTI International, Chicago, IL, United States; Jonathan M. Davis, Tufts University School of Medicine, Boston, MA, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States; Brenda Poindexter, Children's Healthcare of Atlanta, Atlanta, GA, United States; Myriam Peralta-Carcelen, University of Alabama at Birmingham, Birmingham, AL, United States; Jamie E. Newman, RTI International, Research Triangle Park, NC, United States; Catherine Limperopoulos, Children's National Health System, Washington DC, DC, United States; Scott A. Lorch, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States; Deanne Wilson-Costello, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Carla M. Bann, RTI International, Apex, NC, United States

Background: Children with prenatal opioid exposure are at increased risk for adverse neurodevelopmental outcomes compared to unexposed children. However, previous research has not adequately accounted for important confounding factors such as the home environment, parenting, and caregiver mental health.

Objective: To evaluate differences in cognitive outcomes in opioid-exposed and unexposed infants at 12 months of age after accounting for important covariates

Design/Methods: Infants ≥37 weeks gestation with prenatal opioid exposure and unexposed controls enrolled in the prospective longitudinal Outcomes of Babies with Opioid Exposure (OBOE) study underwent the Developmental Assessment of Young Children, 2nd edition (DAYC-2) with a trained examiner between 12-14 months of age. Home visits were conducted using the Home Observation Measurement of the Environment (HOME) Inventory to assess the home environment and parental involvement with the child. Linear regression models were used to evaluate associations of sociodemographic characteristics with scores on the DAYC-2 Cognitive domain. Hot deck imputation was used for missing values.

Results: Of 310 infants enrolled in the OBOE study, 233 had complete data for both the DAYC-2 and HOME at 12 months of age (Table 1). On average, DAYC-2 cognitive scores were 3.77±1.27 points lower among opioid-exposed infants compared to unexposed infants (p=0.003) (Table 2). These differences remained after controlling for sociodemographic characteristics including the HOME Inventory total score (mean difference 3.11±1.47 points, p=0.035). Significant associations were found between higher DAYC-2 cognitive scores and a higher HOME inventory total score (p < 0.001), lower child age at the time of DAYC-2 assessment (p=0.036), lower caregiver depression scores (p=0.003), and whether the child had a change in custody in the past 6 months (p=0.009).

Conclusion(s): In this longitudinal study of infants with prenatal opioid exposure and controls, there were significant differences between groups in cognitive scores at 12 months of age after adjusting for important covariates. This suggests that opioid exposure is an independent predictor of lower cognition in infancy. As 12 months of age is an early timepoint to assess cognitive outcomes, further follow-up is needed.

Table 1
Demographic Characteristics

Table 2
Mean DAYC-2 Cognitive Scores by Demographics and HOME Assessment