Children exposed to prescription opioids in the womb were 28% more likely to be admitted to hospital, with the greatest excess risk seen during infancy and for respiratory illness and infection.
Children exposed in the womb to prescription opioids had a higher chance of being admitted to hospital during childhood, with the sharpest increase seen in respiratory illness and infection, according to a new study published in PLOS Medicine. The research team, led by Dong Keon Yon of Kyung Hee University College of Medicine in South Korea, analysed South Korea’s nationwide health insurance data for nearly 2.93 million children born between 2010 and 2017 and followed some of them for as long as 14 years. They defined exposure as a mother having filled at least two opioid prescriptions during pregnancy.
The study found that children with prenatal opioid exposure had a 28% higher hospital admission rate than unexposed children, and the pattern remained when researchers compared brothers and sisters within the same family, although the difference was smaller. Admissions rose in step with dose: the higher the maternal opioid exposure, the greater the child’s risk. The strongest signal appeared in the earliest years of life, especially infancy, and the excess risk diminished markedly after age five. Respiratory, gastrointestinal, genitourinary and infectious conditions all contributed to the broader pattern.
The authors said the findings do not mean opioids should never be used in pregnancy, but they do argue for restraint and follow-up. Hyeon Jin Kim, a joint first author, said opioids should be prescribed at the lowest effective dose for the shortest possible time, with closer routine checks for children born after exposure, particularly during infancy. The researchers also cautioned that their data captured prescriptions filled rather than medication actually taken, and that some family-level factors could still have influenced the results.
The new paper adds to a wider body of evidence suggesting that prenatal opioid exposure may affect child health beyond the newborn period. A 2023 systematic review of 79 studies found overall negative trends for neurodevelopment, including problems with cognition, motor skills and behaviour, though the evidence varied widely in quality and methods. A 2019 meta-analysis also linked prenatal opioid exposure with lower cognitive scores, while later cohort and review data have pointed to higher risks of infection, attention difficulties and other developmental concerns in childhood. Together, the findings reinforce the need for careful prescribing in pregnancy and for paediatric follow-up after birth.
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