buprenorphine and Developmental-Disabilities

Heroin use in pregnancy is a worldwide problem. Methadone maintenance treatment has definite advantages for the mother and is currently recommended in the UK. There is, however, increasing evidence of adverse effects upon developing cortical and visual function in children of treated heroin-addicted mothers. The longer-term implications of this are not yet clear, and are confounded by poly-drug misuse and ongoing social deprivation. There is a paucity of evidence regarding outcome for infants who require pharmacological treatment for neonatal abstinence syndrome compared to those who have only mild symptoms. Well-controlled studies of the treatment of heroin misuse in pregnancy that take account of both neonatal and longer term outcomes for the child are urgently required.

Topics: Buprenorphine; Child, Preschool; Developmental Disabilities; Female; Heroin Dependence; Humans; Infant; Infant, Newborn; Maternal-Fetal Exchange; Methadone; Opiate Substitution Treatment; Pregnancy; Pregnancy Complications; Prenatal Care; Prenatal Exposure Delayed Effects

Opioid maintenance therapy (OMT) is generally recommended for pregnant opioid-dependent women. Previous studies investigating the long-term effects of OMT on children's cognitive development found that children of women in OMT have an increased risk of developing deficits in motor and visual perceptual skills, which are important aspects of the mirror neurone system (MNS), a complex neural circuit involved in learning and social interactions. The aim of the current study was to investigate aspects of the MNS in children of women in OMT.. A 2 (control group versus OMT group) × 2 (human versus mechanic) mixed factorial design.. The Cognitive Developmental Research Unit at the University of Oslo, Norway.. Fifteen children of women in OMT and 15 non-exposed children participated.. Goal-directed eye movements were recorded using a Tobii 1750 eye tracker. Neurocognitive tests were employed to map children's cognitive development.. The OMT group made fewer proactive goal-directed eye movements [mean = -37.73, standard deviation (SD) = 208.56] compared to the control group (mean = 181.47, SD = 228.65), F((1,28)) = 7.53, P = 0.01, η(2) = 0.21. No differences were found on tests of visual perception or goal understanding.. Use of opioid maintenance therapy during pregnancy appears to be associated with impaired goal-directed eye movements in the 4-year-old infant which may affect later social adjustment adversely.

Topics: Adult; Analysis of Variance; Buprenorphine; Case-Control Studies; Child, Preschool; Developmental Disabilities; Eye Movement Measurements; Female; Humans; Male; Maternal Age; Methadone; Mirror Neurons; Narcotics; Neuropsychological Tests; Nystagmus, Pathologic; Opiate Substitution Treatment; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects

Substitution treatment of opioid-dependent addicts was introduced in Norway in 1998. During the last 10 years, approximately 150 infants have been born to mothers taking part in this programme.. 10 mothers, who took part in the substitution treatment programme, gave birth to 15 infants at Haukeland University Hospital in the period 1999-2005. The infants were observed and monitored at the Department of Pediatrics, Haukeland University Hospital.. During pregnancy, six of the infants were only exposed to opiates, i.e methadone or buprenorphine. Eight infants were also exposed to heroine, benzodiazepines or cannabis. As a group, these infants had lower birth weight than the national average. 14 of the 15 children developed neonatal abstinence syndrome (NAS), 10 needed treatment and two children died from sudden infant death syndrome (SIDS). Long-term follow-up showed that six of 13 children had normal psychomotor development, five had various degrees of delayed psychomotor development and two children had symptoms indicating a hyperkinetic disorder. Five children were in foster care.. Infants of women included in substitution treatment programmes for drug addicts are at high risk compared to infants of women without such addiction. For the newborn, NAS was a frequent complication. The study also showed that symptoms of hyperkinetic disorder and delayed psychomotor development were common. Children who had been exposed to opiates in combination with additional drugs seemed to have a high risk of delayed development and behaviour disorders. As they get older many were placed in foster care, despite well-coordinated, multidisciplinary treatment for the mother.

Topics: Buprenorphine; Developmental Disabilities; Female; Humans; Infant, Newborn; Methadone; Narcotics; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Psychomotor Disorders; Risk Factors