Infants’ prenatal exposure to opioids and the association with birth outcomes: A systematic review and meta‐analysis
Bibliographic record
Abstract
Abstract Background Prenatal exposure to opioids (PEO) is a worldwide public health issue. Opioids cross the placental barrier and may affect the developing foetus and the birth outcomes. Objectives This review aimed to explore newborns’ weight, length and head circumference, preterm birth, and perinatal death as primary outcomes in relation to PEO. The secondary outcomes were gestational age at birth, Apgar scores and length of hospitalisation after delivery. Data sources PubMed, Embase, PsycInfo and the Web of Science. Study selection and data extraction Inclusion criteria were (i) cohort, case‐control or cross‐sectional peer‐reviewed studies published in English through 1 March 2021; (ii) comparing outcomes between prenatal exposed and unexposed groups to opioids (prescribed or obtained illegally). Exclusion criteria were foetal alcohol syndrome and non‐opioid primary exposure. Synthesis Data were extracted by two authors. The Newcastle‐Ottawa Quality Assessment Scale was used for study quality assessment. Due to heterogeneity across studies, we used random effects models to obtain pooled standardised mean difference (SMD), pooled risk ratio (RR) and 95% confidence interval (CI). Results Data from 80 studies were extracted. In meta‐analyses, opioid‐exposed neonates had lower birthweight (SMD −0.77, 95% CI −0.90, −0.64, I2 = 82%), smaller head circumference (SMD −0.67, 95% CI −0.86, −0.48, I2 = 84%), shorter birth length (SMD −0.97, 95% CI −1.24, −0.70, I2 = 91%) and gestational age (SMD −0.45, 95% CI −0.60, −0.30, I2 = 80%) than unexposed neonates. Pooled risks of neonatal death and preterm birth were higher among opioid‐exposed compared to unexposed neonates (RR 4.05, 95% CI 2.12, 7.72, I2 = 73%; and RR 1.92, 95% CI 1.57, 2.35, I2 = 99%). Conclusions We found increased risks of adverse birth outcomes in relation to PEO. Caution should be used in interpreting the findings, as many studies were rated as poor quality, and with substantial inter‐study heterogeneity. Future studies should ensure comparability of opioid‐exposed and ‐unexposed group to strengthen internal validity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.027 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.028 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".