Prenatal opioid exposure, and health, social, and educational outcomes for school-aged children: a systematic review

Louise Marryat; Shona  Shinwell; Catriona Connell; Dawood Gashgari; Alison McFadden; Gale Macleod; Anne Whittaker; Senga Robertson-Albertyn; Vicky Mitchell

doi:10.1111/add.70510

Prenatal opioid exposure, and health, social, and educational outcomes for school-aged children: a systematic review

Louise Marryat (Lead / Corresponding author)
, Shona Shinwell
, Catriona Connell
, Dawood Gashgari
, Alison McFadden
, Gale Macleod
, Anne Whittaker
, Senga Robertson-Albertyn
, Vicky Mitchell

Health Sciences

Research output: Contribution to journal › Article › peer-review

3 Downloads (Pure)

Abstract

Background and aims
Recent decades have seen a rise in the number of pregnancies exposed to opioids. Whilst evidence of the impact of such exposure on pregnancy and infant outcomes is fairly robust, the impact of prenatal opioid exposure (POE) on longer-term outcomes for children and young people remains unclear. This systematic review aimed to examine comprehensively the evidence of the association between prenatal exposure to illicit opioids or medication for opioid use disorder (MOUD) and school-age health, social and educational outcomes.

Methods
PubMed, Web of Science, Scopus and CINAHL were searched for papers published between 1 January 2015 and 13 February 2025, with a follow-up search conducted on 28 October 2025. Grey literature was searched through Google. Eligible studies could be quantitative or qualitative in nature, reporting empirical findings exploring POE (illicit opioids or MOUD) and health, educational or social outcomes at ages 5–18 years. Editorials, case reports, literature reviews, commentaries and conference abstracts, as well as non-English language papers, were excluded. Records were screened by two authors. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies – of Exposure (ROBINS-E) Tool. Due to heterogeneity within both exposures and outcomes, results were synthesised narratively.

Results
Thirty-two papers comprising 16 studies were identified. Quality was mixed: 17/32 papers had high/very high risk of bias, primarily stemming from longitudinal attrition and lack of controlling for confounding. Five very high risk papers were excluded, leaving 27 included papers. Overall, 31 104 children exposed to opioids and 5 430 272 controls were included. Papers spanned 10 countries, primarily in North America, Australasia and Europe. Study designs 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. The most robust evidence of an association with POE was for poorer visual outcomes (e.g. general eye disorders, failure of standard visual assessments and specific impairments including strabismus and nystagmus) (4/4 studies indicating an association) and increased hyperactivity and attention difficulties (3/3 studies reporting an association). A majority of studies (n = 7/10) reported an association with increased cognitive difficulties across various measures. Results for physical health and brain structure/functioning were inconclusive. Evidence was based on few studies for each domain, often with low numbers of participants.

Conclusions
Prenatal opioid exposure through illicit opioids or medication for opioid use disorder is associated with visual outcomes, hyperactivity and inattention and cognitive functioning at 5–18 years. Almost all research focusses on 5–12 years, with little evidence available for adolescents.

Original language	English
Number of pages	13
Journal	Addiction
Early online date	21 Jul 2026
DOIs	https://doi.org/10.1111/add.70510
Publication status	E-pub ahead of print - 21 Jul 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

adolescent
child development
education
health
mothers
neonatal abstinence syndrome
opioid
pregnancy
prenatal drug exposure
systematic review

ASJC Scopus subject areas

Medicine (miscellaneous)
Psychiatry and Mental health

Access to Document

10.1111/add.70510Licence: CC BY

Final Published VersionFinal published version, 1.1 MBLicence: CC BY

Cite this

@article{bf0899b22e0741a7ad0c752372ed3619,

title = "Prenatal opioid exposure, and health, social, and educational outcomes for school-aged children: a systematic review",

abstract = "Background and aims Recent decades have seen a rise in the number of pregnancies exposed to opioids. Whilst evidence of the impact of such exposure on pregnancy and infant outcomes is fairly robust, the impact of prenatal opioid exposure (POE) on longer-term outcomes for children and young people remains unclear. This systematic review aimed to examine comprehensively the evidence of the association between prenatal exposure to illicit opioids or medication for opioid use disorder (MOUD) and school-age health, social and educational outcomes. Methods PubMed, Web of Science, Scopus and CINAHL were searched for papers published between 1 January 2015 and 13 February 2025, with a follow-up search conducted on 28 October 2025. Grey literature was searched through Google. Eligible studies could be quantitative or qualitative in nature, reporting empirical findings exploring POE (illicit opioids or MOUD) and health, educational or social outcomes at ages 5–18 years. Editorials, case reports, literature reviews, commentaries and conference abstracts, as well as non-English language papers, were excluded. Records were screened by two authors. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies – of Exposure (ROBINS-E) Tool. Due to heterogeneity within both exposures and outcomes, results were synthesised narratively. Results Thirty-two papers comprising 16 studies were identified. Quality was mixed: 17/32 papers had high/very high risk of bias, primarily stemming from longitudinal attrition and lack of controlling for confounding. Five very high risk papers were excluded, leaving 27 included papers. Overall, 31 104 children exposed to opioids and 5 430 272 controls were included. Papers spanned 10 countries, primarily in North America, Australasia and Europe. Study designs 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. The most robust evidence of an association with POE was for poorer visual outcomes (e.g. general eye disorders, failure of standard visual assessments and specific impairments including strabismus and nystagmus) (4/4 studies indicating an association) and increased hyperactivity and attention difficulties (3/3 studies reporting an association). A majority of studies (n = 7/10) reported an association with increased cognitive difficulties across various measures. Results for physical health and brain structure/functioning were inconclusive. Evidence was based on few studies for each domain, often with low numbers of participants. Conclusions Prenatal opioid exposure through illicit opioids or medication for opioid use disorder is associated with visual outcomes, hyperactivity and inattention and cognitive functioning at 5–18 years. Almost all research focusses on 5–12 years, with little evidence available for adolescents.",

keywords = "adolescent, child development, education, health, mothers, neonatal abstinence syndrome, opioid, pregnancy, prenatal drug exposure, systematic review",

author = "Louise Marryat and Shona Shinwell and Catriona Connell and Dawood Gashgari and Alison McFadden and Gale Macleod and Anne Whittaker and Senga Robertson-Albertyn and Vicky Mitchell",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Addiction published by John Wiley \& Sons Ltd on behalf of Society for the Study of Addiction.",

year = "2026",

month = jul,

day = "21",

doi = "10.1111/add.70510",

language = "English",

journal = "Addiction",

issn = "0965-2140",

publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Prenatal opioid exposure, and health, social, and educational outcomes for school-aged children

T2 - a systematic review

AU - Marryat, Louise

AU - Shinwell , Shona

AU - Connell, Catriona

AU - Gashgari, Dawood

AU - McFadden, Alison

AU - Macleod, Gale

AU - Whittaker, Anne

AU - Robertson-Albertyn, Senga

AU - Mitchell, Vicky

PY - 2026/7/21

Y1 - 2026/7/21

N2 - Background and aims Recent decades have seen a rise in the number of pregnancies exposed to opioids. Whilst evidence of the impact of such exposure on pregnancy and infant outcomes is fairly robust, the impact of prenatal opioid exposure (POE) on longer-term outcomes for children and young people remains unclear. This systematic review aimed to examine comprehensively the evidence of the association between prenatal exposure to illicit opioids or medication for opioid use disorder (MOUD) and school-age health, social and educational outcomes. Methods PubMed, Web of Science, Scopus and CINAHL were searched for papers published between 1 January 2015 and 13 February 2025, with a follow-up search conducted on 28 October 2025. Grey literature was searched through Google. Eligible studies could be quantitative or qualitative in nature, reporting empirical findings exploring POE (illicit opioids or MOUD) and health, educational or social outcomes at ages 5–18 years. Editorials, case reports, literature reviews, commentaries and conference abstracts, as well as non-English language papers, were excluded. Records were screened by two authors. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies – of Exposure (ROBINS-E) Tool. Due to heterogeneity within both exposures and outcomes, results were synthesised narratively. Results Thirty-two papers comprising 16 studies were identified. Quality was mixed: 17/32 papers had high/very high risk of bias, primarily stemming from longitudinal attrition and lack of controlling for confounding. Five very high risk papers were excluded, leaving 27 included papers. Overall, 31 104 children exposed to opioids and 5 430 272 controls were included. Papers spanned 10 countries, primarily in North America, Australasia and Europe. Study designs 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. The most robust evidence of an association with POE was for poorer visual outcomes (e.g. general eye disorders, failure of standard visual assessments and specific impairments including strabismus and nystagmus) (4/4 studies indicating an association) and increased hyperactivity and attention difficulties (3/3 studies reporting an association). A majority of studies (n = 7/10) reported an association with increased cognitive difficulties across various measures. Results for physical health and brain structure/functioning were inconclusive. Evidence was based on few studies for each domain, often with low numbers of participants. Conclusions Prenatal opioid exposure through illicit opioids or medication for opioid use disorder is associated with visual outcomes, hyperactivity and inattention and cognitive functioning at 5–18 years. Almost all research focusses on 5–12 years, with little evidence available for adolescents.

AB - Background and aims Recent decades have seen a rise in the number of pregnancies exposed to opioids. Whilst evidence of the impact of such exposure on pregnancy and infant outcomes is fairly robust, the impact of prenatal opioid exposure (POE) on longer-term outcomes for children and young people remains unclear. This systematic review aimed to examine comprehensively the evidence of the association between prenatal exposure to illicit opioids or medication for opioid use disorder (MOUD) and school-age health, social and educational outcomes. Methods PubMed, Web of Science, Scopus and CINAHL were searched for papers published between 1 January 2015 and 13 February 2025, with a follow-up search conducted on 28 October 2025. Grey literature was searched through Google. Eligible studies could be quantitative or qualitative in nature, reporting empirical findings exploring POE (illicit opioids or MOUD) and health, educational or social outcomes at ages 5–18 years. Editorials, case reports, literature reviews, commentaries and conference abstracts, as well as non-English language papers, were excluded. Records were screened by two authors. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies – of Exposure (ROBINS-E) Tool. Due to heterogeneity within both exposures and outcomes, results were synthesised narratively. Results Thirty-two papers comprising 16 studies were identified. Quality was mixed: 17/32 papers had high/very high risk of bias, primarily stemming from longitudinal attrition and lack of controlling for confounding. Five very high risk papers were excluded, leaving 27 included papers. Overall, 31 104 children exposed to opioids and 5 430 272 controls were included. Papers spanned 10 countries, primarily in North America, Australasia and Europe. Study designs 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. The most robust evidence of an association with POE was for poorer visual outcomes (e.g. general eye disorders, failure of standard visual assessments and specific impairments including strabismus and nystagmus) (4/4 studies indicating an association) and increased hyperactivity and attention difficulties (3/3 studies reporting an association). A majority of studies (n = 7/10) reported an association with increased cognitive difficulties across various measures. Results for physical health and brain structure/functioning were inconclusive. Evidence was based on few studies for each domain, often with low numbers of participants. Conclusions Prenatal opioid exposure through illicit opioids or medication for opioid use disorder is associated with visual outcomes, hyperactivity and inattention and cognitive functioning at 5–18 years. Almost all research focusses on 5–12 years, with little evidence available for adolescents.

KW - adolescent

KW - child development

KW - education

KW - health

KW - mothers

KW - neonatal abstinence syndrome

KW - opioid

KW - pregnancy

KW - prenatal drug exposure

KW - systematic review

UR - https://www.scopus.com/pages/publications/105045256937

U2 - 10.1111/add.70510

DO - 10.1111/add.70510

M3 - Article

SN - 0965-2140

JO - Addiction

JF - Addiction

ER -

Prenatal opioid exposure, and health, social, and educational outcomes for school-aged children: a systematic review

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Improving Outcomes For Children Exposed To Opioids In Pregnancy Across The World: An International Longitudinal Administrative Data Study (Joint with Universities: Stirling, Edinburgh & UCL)

Cite this

Prenatal opioid exposure, and health, social, and educational outcomes for school-aged children: a systematic review

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Projects

Improving Outcomes For Children Exposed To Opioids In Pregnancy Across The World: An International Longitudinal Administrative Data Study (Joint with Universities: Stirling, Edinburgh & UCL)

Cite this