An interdisciplinary team of experts from Indiana University, along with other researchers across the U.S. and Sweden, have received grants totaling over $1.6 million to study the effects that opioid pain medications prescribed during pregnancy have on children.
The grants to Brian D'Onofrio, a clinical psychology researcher in the IU Bloomington College of Arts and Sciences' Department of Psychological and Brain Sciences, and colleagues are $1.22 million from the National Institute on Drug Abuse and $400,000 from the Swedish Research Council.
The researchers will examine whether causal connections exist between mothers who use prescribed opioids for pain treatment during pregnancy and adverse outcomes in children, such as preterm birth, reduced fetal growth, autism spectrum disorder and attention deficit hyperactivity disorder, known as ADHD. The work could provide doctors and pregnant women with better guidelines for their prescriptions, D'Onofrio said.
The use of prescribed opioid medication to treat severe and chronic pain is an issue of great concern within the medical and health care community due to the increasing prevalence of opioid pain medication across the globe. Nearly 50 percent of pregnant women experience moderate to severe pain -- with a growing number who receive prescribed opioids.
D'Onofrio and colleagues' research will improve upon past research into the use of prescribed opioid pain medications during pregnancy, said Ayesha Sujan, a Ph.D. student in the Department of Psychological and Brain Sciences and a member of D'Onofrio's team.
For example, by comparing the children of those who are taking medication and those who are not, she said, earlier studies failed to account for other strong differences between the two groups, such as socioeconomic status, or physical and mental health, which could also account for differences in their children.
The new research will seek to overcome shortfalls of previous studies through an innovative approach that includes:
- The use of Sweden's comprehensive medical records from 1996 to 2017, which will provide an extensive dataset to significantly strengthen the validity of results. The researchers will use these records to construct a profile of the common characteristics among pregnant women who have used prescribed opioids for the treatment of pain, improving understanding of the possible factors contributing to negative outcomes in children.
- The use of the large dataset to bring these other factors into focus. The researchers will compare the children of pregnant patients who have used prescribed opioids to other groups, including siblings who were not similarly exposed to opioids; the children of women taking pain medications other than opioids (e.g., acetaminophen) during pregnancy; and the children of fathers who took prescribed opioids while the mother was pregnant.
If differences are found in birth outcomes within these groups, then it’s likely opioid use during pregnancy is the cause. If differences are not found, then it’s likely other shared qualities within these groups are the cause.
The results could have a significant impact on patients’ lives. In some cases, an opioid prescription may be superior to untreated maternal pain during pregnancy, added Sujan, whose research interests extend to the use of other medications during pregnancy.
"We always try to think, 'What's the alternative?'" she said. "It may be greater hardship, if the mom cannot go to work or she cannot take care of herself or her kids without the medication. And so far, we have no good science to show that the medication itself is bad for children or worse than a woman's underlying condition. The drug could be the best alternative."
Additional researchers on the National Institute on Drug Abuse grant include Patrick Quinn, an assistant professor at the IU School of Public Health-Bloomington, and Sara Oberg and Paul Lichtenstein at the Karolinska Institutet in Sweden. Oberg and Lichtenstein are also researchers on the Swedish Research Council grant.
This study reflects IU's extensive expertise and research regarding addictions. To build on this area of strength, IU President Michael A. McRobbie, along with Indiana Gov. Eric Holcomb and IU Health President and CEO Dennis Murphy, announced the Responding to the Addictions Crisis Grand Challenge initiative in October 2017.