- 50% of children with prenatal substance exposure had developmental vulnerability or diagnosed conditions at school entry, versus 24% of other children.
- Vulnerability on two or more developmental domains affected 24% of exposed children compared with 9% of other children.
- Findings highlight need for interagency prevention and continuous services from substance use in pregnancy through postnatal and early childhood supports.
J Epidemiol Community Health. 2026 Sep 18:jech-2026-226050. doi: 10.1136/jech-2026-226050. Online ahead of print.
ABSTRACT
OBJECTIVES: We quantified the risk of developmental support needs at school entry among children with and without prenatal substance exposure, to inform service delivery initiatives in the first 2000 days of children’s lives.
METHODS: We assembled a cohort using population-level perinatal, birth registration, hospital and education data linked for the New South Wales Child E-Cohort. Children born 2008-2014, with Australian Early Development Census data collected 2015, 2018, 2021 (n=262 968), were grouped into children with and without prenatal substance exposure (using indicators in mother/child hospital, emergency department, mental health outpatient, opioid treatment and/or child protection report data). We quantified the risk of developmental support needs, including teacher-reported developmental vulnerability on ≥1 of five domains or medically diagnosed conditions with support needs at school entry.
RESULTS: Half of prenatal substance-exposed children (n=4306) had developmental vulnerability on ≥1 domains or ≥1 medically diagnosed conditions at school entry, compared with 24% of all other children. Developmental vulnerability on ≥2 domains was more common among prenatal substance-exposed children (24%) than all other children (9%). 11% of prenatal substance-exposed children had ≥1 medically diagnosed conditions, versus 5% of all other children. Autism spectrum disorder, attention deficit hyperactivity disorder, global developmental delay and fetal alcohol spectrum disorder were the most common conditions among prenatal substance-exposed children.
CONCLUSIONS: Half of prenatal substance-exposed children had developmental support needs during the first 2000 days of life, highlighting the importance of interagency prevention responses spanning substance use in pregnancy services through to the postnatal and early childhood support services for affected children.
PMID:42760111 | DOI:10.1136/jech-2026-226050
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