The Opioid in Pregnancy Study

The challenge of a global opioid epidemic

We are living through a global opioid epidemic: a recent estimate (from 2019) suggests that, worldwide, 61 million people use opioids. Usage is increasing in women and, alarmingly, simultaneously rising in pregnancy. 

Scotland has the highest rate of opioid use in Europe, with our research identifying around 6,500 babies exposed to opioids over the last 10 years. Despite this, we lack robust evidence about the long-term impact of exposure to opioids in pregnancy. 

Women who use opioids during pregnancy are encouraged to stabilise on Medication Assisted Treatment (MAT) (for example, methadone or buprenorphine) to reduce the risks associated with withdrawal or injecting. However, we know little about the impacts of different types of MAT on the child beyond the preschool period, or whether the treatment provided for Neonatal Abstinence Syndrome (NAS) affects their long-term development. Consequently, this treatment lacks an evidence base. 

Neither clinicians nor mothers have the information they need to make decisions that will affect the long-term health and development of the child. Crucially, this also means that we do not know if children are being unintentionally harmed through this treatment. 

Although relatively small in size, this population are likely to use health and social services disproportionately: understanding the pathways leading to outcomes will enable intervention to support women and children, improve quality of life, and reduce societal costs.

Our study

This study has several different stages. 

Stage 1 (funded by the CSO) allowed us to identify Scottish children exposed to opioids through either illicit substance use or MAT, and to look at their birth and neonatal outcomes. This allowed us to test the data linkages and see if this research was possible.

Stage 2 (funded by UKRI ESRC) runs until 2024 and has two parts:

1. We examined the antenatal care pathways for women who use opioids in three Scottish Health Boards: Lothian, Greater Glasgow and Clyde, and Tayside, to find out how women are supported in this period
2. We explored health and developmental outcomes for Scottish children exposed to opioids in the preschool period

Stage 3 (funded by UKRI through a Future Leaders Fellowship) runs 2024-2031 (provisionally). This stage will explore health, education and justice outcomes for young people up to age 16. As well as exploring these outcomes for Scottish children, we will also explore whether pathways are similar in the rest of the UK, as well as in Scandinavia and Australasia.

Additionally, we have a SGSSS-funded PhD student, Shona Shinwell, looking at the health outcomes for women themselves who use opioids, in the three years following childbirth. 

What we will do

This study primarily uses routinely collected data (e.g. hospital records and education records) to explore the pathways that children who have been exposed to opioids in pregnancy take through life. We will compare these children with a group of children who have been exposed to opioids in pregnancy through chronic pain medication, and a further group of children who have no exposure, but who look demographically similar to our main group of children. 

This will allow us to start to look at whether children’s outcomes are being affected by being exposed to opioids in pregnancy, or whether any differences in outcomes are related to the environment in which children are being brought up. 

Get involved

Although this study does not recruit participants, due to us using routinely-collected data, we are keen to speak to women, and families affected by opioid exposure in pregnancy. 

If you would like to speak to the team about the study and share your thoughts or find out more, please contact the Lead Researcher, Louise Marryat.

Outputs

Hughes, T., McFadden, A., Whittaker, A., Boardman, J. P., & Marryat, L. (2024). Antenatal care of women who use opioids: a qualitative study of practitioners’ perceptions of strengths and challenges of current service provision in Scotland. BMC Pregnancy and Childbirth, 24(1), 75. Antenatal care of women who use opioids: a qualitative study of practitioners’ perceptions of strengths and challenges of current service provision in Scotland | BMC Pregnancy and Childbirth (springer.com) 

Protocols

View protocols online

Project code

Project code will be made available on our github repository.