The impact of opioid misuse on fetal and pediatric populations: a systematic umbrella review
Abstract
The opioid crisis has emerged as a significant public health emergency with far-reaching consequences extending beyond adult populations to fetuses, infants, children, adolescents, and emerging adults. While the majority of opioid research focuses on adults, growing evidence highlights unique impacts on pediatric populations through both direct exposure and indirect effects via caregiver opioid involvement. This umbrella review aimed to systematically synthesize existing evidence on the impact of opioids on children, youth, and adolescents ages 0–24 years. We conducted a systematic review of published systematic reviews, meta-analyses, and scoping reviews following PRISMA guidelines. PubMed, Embase, and CINAHL databases were searched for reviews published since 2014 examining opioid impacts on pediatric populations. Two reviewers independently screened articles and assessed quality using the 11-item Joanna Briggs Institute criteria checklist. Data were extracted and categorized thematically by age group and outcome domain. Twenty studies met inclusion criteria, with review quality scores averaging 5.75 out of 11. Evidence documented impacts across four major categories: physical health, neurodevelopment, psychosocial outcomes, and caregiving disruptions. Effects were most extensively documented in infants with prenatal exposure, with less research available on parental opioid misuse impacting children and adolescent and emerging adult opioid misuse. Environmental factors, particularly socioeconomic status and caregiving quality, emerged as significant moderators of outcomes. Opioid exposure affects children from the prenatal period through emerging adulthood across multiple developmental domains. The interconnected nature of these impacts, combined with environmental risk factors, necessitates comprehensive early intervention approaches addressing healthcare, education, and social services. Research gaps exist regarding adolescents and emerging adults, highlighting areas for future investigation to inform evidence-based interventions and policy decisions.