Emma N. Cleary explains opioid use is not linked to offspring ADHD or autism

A recent study examined the relationship between prenatal opioid use and offspring neurodevelopment, specifically focusing on autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD).

As explained in an interview with Contemporary OB/GYN by Emma N. Cleary, PhD candidate at Indiana University Bloomington, pain management during pregnancy is an important clinical consideration, and opioids are sometimes prescribed when other treatments are insufficient. However, because opioids cross the placenta, there have been concerns about potential long-term impacts on child development.

Previous observational studies have suggested potential associations between prenatal opioid exposure and increased risks for neurodevelopmental disorders, particularly with higher levels of exposure. To address limitations of earlier research, Cleary and her team designed their study to account for key sources of confounding and bias, including genetic and environmental factors that may influence both the likelihood of opioid prescribing and the risk for developmental disorders.

Using Swedish population data, they applied several analytic approaches and consistently found no substantial increase in risk for ASD or ADHD with typical levels of prenatal opioid prescribing. While high-dose or long-term exposures were not well represented in their sample, the findings provide reassurance for patients and clinicians regarding low to moderate opioid use during pregnancy.

Clinically, these results highlight the importance of balancing maternal pain management with concerns about fetal outcomes. Adequate pain control during pregnancy is vital not only for maternal well-being but also for promoting healthy development and functioning. Cleary emphasized that while their findings reduce concerns about neurodevelopmental risks from judicious opioid use, other potential outcomes such as preterm birth remain areas for ongoing investigation.

For clinicians navigating patient concerns, the study suggests that individualized, evidence-informed discussions are critical. Patients can be reassured that, at least in moderate prescribing contexts, opioid use does not appear to substantially increase risks for ASD or ADHD once confounding factors are accounted for. However, it is still important to consider alternative pharmacological and non-pharmacological pain management strategies where appropriate.

Cleary also noted that replication studies in other populations and contexts are needed to confirm these findings and to explore potential risks at higher doses or with chronic use. Overall, the research contributes valuable evidence to support clinical decision-making, helping providers and patients weigh the benefits of pain relief against possible developmental risks in an informed and individualized manner.

No relevant disclosures.

References:

1. Cleary EN, Sujan AC, Rickert ME, et al. Prescribed opioid analgesic use in pregnancy and risk of neurodevelopmental disorders in children: A retrospective study in Sweden. PLoS Medicine. 2025;22(9):e1004721-e1004721. doi:https://doi.org/10.1371/journal.pmed.1004721
2. PLOS. Prescribed opioid pain medications during pregnancy likely aren’t associated with increased risk of autism, ADHD. Eurekalert. September 16, 2025. Accessed September 19, 2025.