Improving outcomes for children exposed to opioids in pregnancy across the world: an international longitudinal administrative data study
Lead Research Organisation:
University of Dundee
Department Name: Health Sciences
Abstract
Worldwide, opioid use (e.g. heroin) is now viewed as a 'crisis'. Men are more likely to use opioids, but in recent years there has been a greater increase in the numbers of women using opioids. As a consequence, the numbers of pregnancies where opioid use is a factor is also increasing. There is already strong evidence that opioid use in pregnancy harms the unborn child, but very little is known about the long-term outcomes for these children: they are difficult to follow-up over a long time period using traditional methods, such as repeated face-to-face interviews, due to the complexity of their lives.
Scotland is in a rare position of being able to link all health data across a person's lifetime, as well as linking mother and child data, not readily available in all countries, and having high levels of opioid use. As a first step, I have shown that we can identify women who use illicit or prescription opioids in pregnancy from the health data we already collect routinely (e.g. antenatal records, hospital records) in Scotland and this can be matched to equivalent data from their children. This gives us a way of exploring longer term outcomes.
The proposed research will be the first to analyse a population-based cohort of children exposed to opioids in pregnancy through to adolescence. This will allow us to explore a range of health, education and justice outcomes for children in Scotland, and to explore the pathways they take to these outcomes. The outcomes of children who were exposed to opioids through their mother's substance use will be compared with children in two other groups: 1) mothers who used opioids for chronic pain in pregnancy, and 2) children who are from similar socio-economic backgrounds but who were not exposed to opioids.
We also don't know much about how drugs pass through to the unborn child during pregnancy, as the effects on the child do not seem to be directly linked to the mother's consumption. I will work with a forensic chemist to develop a test which changes colour depending on the type and amount of drugs (e.g. heroin, morphine, methadone) detected in blood samples. In Phase 1 this will be developed using animal bloods. In phase 2 we plan to test this on blood collected from the umbilical cord. During Phase 1 I will work with mothers who use opioids to gather information on their views and potential concerns around the use of cord blood, in order to ensure this research is conducted sensitively in Phase 2.
There are other countries with excellent data linkage systems, but with smaller numbers of babies exposed to opioids in pregnancy. The second stage of this study will be to develop international collaborations, in order to access datasets from some Scandinavian and Commonwealth countries (New Zealand, Australia) and to test the pathways found on the Scottish data on these international datasets. In the rest of the UK, it is difficult to bring data together to the same degree as in Scotland. We will therefore work with other UK nations to improve these data linkages. This will mean that later in the study we can analyse data for the whole of the UK in a similar way to the Scottish data.
Throughout the project we will work with women who use opioids, young adults whose mothers used opioids, and the charity organisations and policy-makers who support these families. This will ensure that we are asking the right questions and will be able to create useful and meaningful recommendations for future research and intervention.
The results of this study will help us to understand the effects on children of opioid use during pregnancy and allow us to explore promising approaches for interventions to improve the support that is currently provided to women, adoptive families, and their children. Our findings will ensure that women across the world are given accurate information about the impact of opioid use in pregnancy to help provide their children with the best start in life.
Scotland is in a rare position of being able to link all health data across a person's lifetime, as well as linking mother and child data, not readily available in all countries, and having high levels of opioid use. As a first step, I have shown that we can identify women who use illicit or prescription opioids in pregnancy from the health data we already collect routinely (e.g. antenatal records, hospital records) in Scotland and this can be matched to equivalent data from their children. This gives us a way of exploring longer term outcomes.
The proposed research will be the first to analyse a population-based cohort of children exposed to opioids in pregnancy through to adolescence. This will allow us to explore a range of health, education and justice outcomes for children in Scotland, and to explore the pathways they take to these outcomes. The outcomes of children who were exposed to opioids through their mother's substance use will be compared with children in two other groups: 1) mothers who used opioids for chronic pain in pregnancy, and 2) children who are from similar socio-economic backgrounds but who were not exposed to opioids.
We also don't know much about how drugs pass through to the unborn child during pregnancy, as the effects on the child do not seem to be directly linked to the mother's consumption. I will work with a forensic chemist to develop a test which changes colour depending on the type and amount of drugs (e.g. heroin, morphine, methadone) detected in blood samples. In Phase 1 this will be developed using animal bloods. In phase 2 we plan to test this on blood collected from the umbilical cord. During Phase 1 I will work with mothers who use opioids to gather information on their views and potential concerns around the use of cord blood, in order to ensure this research is conducted sensitively in Phase 2.
There are other countries with excellent data linkage systems, but with smaller numbers of babies exposed to opioids in pregnancy. The second stage of this study will be to develop international collaborations, in order to access datasets from some Scandinavian and Commonwealth countries (New Zealand, Australia) and to test the pathways found on the Scottish data on these international datasets. In the rest of the UK, it is difficult to bring data together to the same degree as in Scotland. We will therefore work with other UK nations to improve these data linkages. This will mean that later in the study we can analyse data for the whole of the UK in a similar way to the Scottish data.
Throughout the project we will work with women who use opioids, young adults whose mothers used opioids, and the charity organisations and policy-makers who support these families. This will ensure that we are asking the right questions and will be able to create useful and meaningful recommendations for future research and intervention.
The results of this study will help us to understand the effects on children of opioid use during pregnancy and allow us to explore promising approaches for interventions to improve the support that is currently provided to women, adoptive families, and their children. Our findings will ensure that women across the world are given accurate information about the impact of opioid use in pregnancy to help provide their children with the best start in life.
