Children prenatally exposed to prescription opioids face increased rates of hospital admission, particularly for respiratory illnesses and infections.
RT’s Three Key Takeaways:
- Increased Admission Risk: Children whose mothers filled two or more opioid prescriptions during pregnancy experienced a 28% higher rate of hospital admission compared to unexposed children, driven largely by respiratory illnesses and infections.
- Dose-Dependent Association: Hospital admission rates rose with higher maternal opioid doses, with the greatest vulnerability observed during infancy before diminishing after 5 years of age.
- Targeted Postnatal Care: Researchers recommend prescribing maternal opioids at the lowest effective dose for the shortest duration and scheduling closer pediatric healthcare checks during the first year of life.
Children whose mothers received opioid prescriptions during pregnancy experience higher rates of hospital admission during childhood than unexposed peers, including their unexposed siblings, according to a study published in PLOS Medicine.
The study, led by Dong Keon Yon of Kyung Hee University College of Medicine in South Korea and colleagues, analyzed nationwide healthcare insurance data spanning 2,928,186 children born between 2010 and 2017 who were followed for up to 14 years. The authors classified children as prenatally exposed if their mothers received two or more opioid prescriptions during pregnancy.
Over recent decades, opioid prescriptions and doses have risen in clinical practice, leaving a notable proportion of pregnant women exposed to these medications. In the United States (US), data indicate that 14% to 22% of women fill an opioid prescription during pregnancy. Prior investigations into whether prenatal opioid exposure disrupts infant immune and developmental systems have faced limitations such as confounding variables, limited sample sizes, and short follow-up periods.
Dose-dependent Risks and Respiratory Admissions
The findings demonstrated that children with prenatal opioid exposure had a 28% higher rate of hospital admission than unexposed children (adjusted incidence rate ratio [aIRR] 1.28, 95% confidence interval [CI] 1.28-1.29). When researchers compared siblings within the same family to account for shared familial traits, the association remained statistically significant, though smaller (aIRR 1.08, 95% CI 1.07-1.10).
The elevated risk was dose-dependent, with higher maternal opioid doses linked to higher admission rates (aIRR 1.19 for low-dose exposure compared to 1.40 for high-dose exposure). The higher admission rates spanned multiple diagnostic categories, including respiratory, gastrointestinal, genitourinary, and infectious conditions, with the strongest associations documented up to 5 years of age.
“In a nationwide cohort of nearly three million Korean children, those whose mothers received two or more opioid prescriptions during pregnancy had about a 28% higher rate of hospital admission, most notably for infections and respiratory illness in the first years of life,” said Dong Keon Yon, MD, PhD, co-corresponding author. “The risk rose with higher opioid doses and longer prescriptions, which points to a possible biological effect—but when we compared siblings within the same family, the association shrank considerably, so shared family factors clearly explain part of what we see.”
“Because opioids in South Korea are obtained almost entirely by prescription, our data let us examine prescribed opioid exposure in pregnancy unusually cleanly, and following nearly three million children for up to 14 years gave us the statistical power to look at dose, timing, and specific causes of admission separately,” said Jiseung Kang, PhD, co-corresponding author. “The consistency of the pattern across all of these analyses is what makes the finding hard to dismiss.”
Clinical Implications for Pediatric Care
The study authors highlighted that the heightened vulnerability appears concentrated in early development rather than persisting indefinitely.
“What surprised us most was how quickly the association faded as children grew older,” said Yesol Yim, joint first author. “The excess risk was clearest in the first year of life and had largely disappeared after age five. That pattern suggests a window of vulnerability in early infancy rather than a lifelong effect—and it is a window in which pediatric follow-up can make a real difference.”
While opioids remain a necessary option for managing severe pain in certain clinical scenarios, the authors emphasized the value of careful prescribing and vigilant postnatal follow-up.
“Our message is not that pregnant women should never receive opioids—for some, pain relief is essential,” said Hyeon Jin Kim, MS, joint first author. “It is that opioids in pregnancy should be prescribed at the lowest effective dose for the shortest time, and that children born after such exposure may benefit from closer routine health checks, particularly in infancy when the risk was highest.”
The authors noted that the results should be interpreted with caution because the study relied on electronic healthcare records, which track prescription fills rather than confirmed ingestion, and unmeasured familial factors could account for part of the observed relationship. Nonetheless, the team concluded that the findings indicate a clear need for additional postnatal healthcare checks for infants born to mothers who were prescribed opioids during pregnancy.
