Prenatal opioid exposure shows minimal effects on later academic performance

According to the Centers for Disease Control and Prevention, every 25 minutes in the United States, a child is diagnosed with neonatal abstinence syndrome (NAS), a condition that occurs in newborns who are exposed to opioids in the womb and develop withdrawal after birth. Historically, research has focused on the impact of NAS – also known as neonatal opioid withdrawal syndrome – on the health and development of young children, finding that prenatal opioid exposure is associated with an increased risk of adverse developmental, cognitive, and behavioral outcomes in early childhood.

However, according to a new study led by researchers at Penn State College of Medicine, by the time children with NAS reach the classroom, opioid exposure may play a minimal role in neurodevelopmental outcomes. They compared school-age children with and without a history of NAS and found that both groups performed similarly on standardized tests when socioeconomic and environmental factors were taken into account. The findings suggest that external factors such as school quality, economic status, race, and mother’s level of education have a greater impact on educational outcomes. This study was published in the journal Lancet Regional Health – Americas.

Historically, we have been quick to blame prenatal opioid exposure for poor academic achievement, but it appears that socio-environmental factors play a much larger role. There is every reason to believe that given the right resources, these children can do well and thrive.”

Tammy Core, associate professor of pediatrics at Penn State College of Medicine and corresponding author of the study

Academic achievement can be a good indicator of both prior neurodevelopment in childhood and future success as an adult, Corr said. In this study, researchers evaluated standardized test scores for English/language arts and mathematics for 3,494 students in grades three through eight – 23% with a history of NAS and 77% without NAS.

To determine whether test performance was affected by NAS or other factors, researchers compared children with NAS and a control group who were matched for age, sex, mother’s level of education, and type of health insurance at birth.

Data were obtained from the South Carolina Integrated Data System, which integrates data on health, demographics, socioeconomics, social services, and education from multiple state agencies. The researchers reported that this uniquely integrated database can link a mother and child in a way that allows researchers to follow the pair longitudinally over time. While the data comes from South Carolina, Core said the results can be generalized to the broader population in the United States because the socioeconomic and environmental factors present for children with a history of NAS in this study are similar to previously published literature from studies across the United States.

After controlling for age, gender, and socioeconomic factors, there were minimal differences in the standardized test scores of students with and without a history of NAS. Average English/language arts test scores were similar between the two groups. In mathematics, there was a small but statistically significant decline in test scores among students with a history of NAS.

Overall, children in the study scored below the state average in all grades, regardless of NAS history. While the children in the study were from across the state, because of the matching strategy, more than 30% were born to mothers with less than a high school degree, and 85% were either uninsured or underinsured by Medicaid, which is typically an indicator of socioeconomic status, the researchers explained.

Factors such as attending a low-rated school, limited access to early childhood education, and other indicators of economic stress, such as participation in the Women, Infants, and Children (WIC) Supplemental Nutrition Program, played a huge role in determining a student’s academic performance. Children of non-Hispanic black mothers also scored approximately one grade level lower than non-Hispanic white students on tests. The researchers also found that test scores increased with increasing levels of maternal education.

“Based on previous literature, I expected to see more prominent differences in academic performance,” Core said. “But when you start to put the whole story together – they didn’t have access to early childhood education to give them a solid start, they’re enrolled in poorly rated schools, their families may be struggling with financial insecurities – it’s not hard to understand why children with a history of NAS are not doing as well as some of their peers.”

The research team will continue to advance this work with the goal of isolating the factors through interviews with parents and guardians of school-age children who have a history of prenatal opioid exposure and NAS to gain a deeper understanding of the day-to-day experiences that may promote or interfere with a child’s success in school.

Other authors on the project include biostatisticians Emily Wasserman and Eric Schaefer, both from Penn State College of Medicine.

Funding from the National Institutes of Health’s National Institute on Drug Abuse supported this work.