University of Maryland researchers will conduct an unprecedented investigation into how fetal exposure to opioids affects children’s brain development and health outcomes—part of a sweeping National Institutes of Health initiative to apply scientific solutions to help reverse the nation’s opioid crisis.

Led by Distinguished University Professor Nathan A. Fox of the College of Education, the researchers will examine how brain growth is affected by pre- and postnatal opioid exposure, and how that causes cognitive and behavioral changes in childhood. 

Nathan A. Fox headshotThe University of Maryland’s award is one of 375 across 41 states made by the National Institutes of Health in fiscal year 2019 through the Helping to End Addiction Long-term, or the NIH HEAL Initiative. The National Institute on Drug Abuse-funded study addresses an urgent public health need: The use of opioids by pregnant women and mothers has increased by 300% since the early 2000s, with the number of newborns with neonatal abstinence syndrome, caused by withdrawal from drugs they were exposed to in the womb, increasing by approximately 400%. In 2016, more than 31,000 babies were born with the syndrome, causing symptoms including tremors and sleep problems.

“We know very little about the effects of early exposure to opioids on brain development,” said Fox, of the Department of Human Development and Quantitative Methodology and a renowned expert in child development. “There has never been a national study of even normative brain development during the early years of life. Our research will help fill a gap in understanding of the basic science of early brain development, as well as identify the effects of early drug exposure on the brain, along with prevention strategies.”

The University of Maryland is part of a five-institution consortium that is laying the groundwork through this initial study for a large-scale national, 10-year longitudinal study that examines the effects of in utero exposure to opioids on children through the age of 8.

The 18-month study will begin in October, with a research team that includes Professor Brenda Jones-Harden of the University of Maryland School of Social Work in Baltimore and psychology Associate Professors Tracy Riggins and Elizabeth Redcay, as well as Luiz Pessoa, professor of psychology and director of the Maryland Neuroimaging Center on the College Park campus.  

Unlike many previous studies, the project will not only examine fetal exposure to opioids like fentanyl and prescription painkillers, but also include pregnant women who are poly-drug users. Following babies as they develop will allow researchers to better understand how opioid and other drug use, in combination with family, environmental and socioeconomic factors, influences babies’ development through childhood.

“For many of these children, this initial exposure to opioids is only the first in a series of challenges they experience that may affect their health and development, and could lead to ‘a crisis cascade’ as they age and interact with school systems and social services,” Fox said. “Our research aims to take a holistic approach to early childhood exposures in order to pinpoint critical areas and timelines for intervention, which will help guide the response to this major public health concern.”

In the initial phase, the University of Maryland researchers will recruit 20 pregnant women (and their infants at age 3 months), including those who use opioids, and 20 12-month-olds and 20 2.5-year-old children from diverse populations at Howard University Hospital and George Washington University Hospital. The study will carefully address ethical concerns relating to the topic of opioid use in pregnancy, and will include an external community advisory board to provide strategic guidance on legal and ethical questions. 

In addition to Maryland, the consortium includes Brown University, Harvard University at Boston Children’s Hospital, Boy’s Town in Omaha, Nebraska, and Avera Health in South Dakota, allowing them to recruit from rural areas that have been hardest hit by the opioid crisis.