{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:10Z","timestamp":1792787290001,"version":"4.5.0"},"reference-count":55,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian Government Department of Health under the Drug and Alcohol Program","award":["2010778"],"award-info":[{"award-number":["2010778"]}],"id":[{"id":"https:\/\/ror.org\/0314h5y94","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Australian Government Research Training Program","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"https:\/\/ror.org\/0314h5y94","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007281","name":"National Drug and Alcohol Research Centre","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100007281","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1187489"],"award-info":[{"award-number":["1187489"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2026,8,28]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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\u2019s lives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u20132014, with Australian Early Development Census data collected 2015, 2018, 2021 (n=262\u2009968), 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 \u22651 of five domains or medically diagnosed conditions with support needs at school entry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Half of prenatal substance-exposed children (n=4306) had developmental vulnerability on \u22651 domains or \u22651 medically diagnosed conditions at school entry, compared with 24% of all other children. Developmental vulnerability on \u22652 domains was more common among prenatal substance-exposed children (24%) than all other children (9%). 11% of prenatal substance-exposed children had \u22651 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jech-2026-226050","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:20:21Z","timestamp":1789752021000},"page":"jech-2026-226050","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Prenatal substance exposure and developmental outcomes at age 5: a population-based cohort of 260\u2009000 children in New South Wales, Australia"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-9900","authenticated-orcid":false,"given":"Madeleine","family":"Powell","sequence":"first","affiliation":[{"name":"National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia"},{"name":"School of Population Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6974-8496","authenticated-orcid":false,"given":"Rhiannon Megan","family":"Pilkington","sequence":"additional","affiliation":[{"name":"BetterStart, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hanly","sequence":"additional","affiliation":[{"name":"Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alys","family":"Havard","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasnia","family":"Ahmed","sequence":"additional","affiliation":[{"name":"School of Population Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BJ","family":"Newton","sequence":"additional","affiliation":[{"name":"Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W","family":"Lynch","sequence":"additional","affiliation":[{"name":"The University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Population Health Sciences, Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Cretikos","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Williamson","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Stewart","sequence":"additional","affiliation":[{"name":"Family and Community Services Insights, Analysis and Research, Department of Communities and Justice, NSW, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2035-5485","authenticated-orcid":false,"given":"Kathleen","family":"Falster","sequence":"additional","affiliation":[{"name":"School of Population Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"2026091810201104000_jech-2026-226050v1.1","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s11121-023-01605-2","article-title":"Systematic Review and Meta-analysis of the Relationship Between Exposure to Parental Substance Use and Attention-Deficit\/Hyperactivity Disorder in Children","volume":"25","author":"Maher","year":"2024","journal-title":"Prev Sci"},{"key":"2026091810201104000_jech-2026-226050v1.2","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2023.1071889","article-title":"Prenatal exposure to opioids and neurodevelopment in infancy and childhood: A systematic review","volume":"11","author":"Balalian","year":"2023","journal-title":"Front Pediatr"},{"key":"2026091810201104000_jech-2026-226050v1.3","doi-asserted-by":"crossref","DOI":"10.1186\/2046-4053-3-1","article-title":"The effect of moderate gestational alcohol consumption during pregnancy on speech and language outcomes in children: a systematic review","volume":"3","author":"O\u2019Keeffe","year":"2014","journal-title":"Syst Rev"},{"key":"2026091810201104000_jech-2026-226050v1.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.7025","article-title":"Cognitive and Motor Outcomes of Children With Prenatal Opioid Exposure: A Systematic Review and Meta-analysis","volume":"2","author":"Yeoh","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026091810201104000_jech-2026-226050v1.5","doi-asserted-by":"crossref","first-page":"104714","DOI":"10.1016\/j.neubiorev.2022.104714","article-title":"Methamphetamine exposure during pregnancy: A meta-analysis of child developmental outcomes","volume":"138","author":"Kunkler","year":"2022","journal-title":"Neurosci Biobehav Rev"},{"key":"2026091810201104000_jech-2026-226050v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.01.007"},{"key":"2026091810201104000_jech-2026-226050v1.7","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1093\/pch\/pxac079","article-title":"Prenatal cannabis use and its impact on offspring neuro-behavioural outcomes: A systematic review","volume":"28","author":"Thompson","year":"2023","journal-title":"Paediatr Child Health"},{"key":"2026091810201104000_jech-2026-226050v1.8","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/add.16370","article-title":"Birth, cognitive and behavioral effects of intrauterine cannabis exposure in infants and children: A systematic review and meta-analysis","volume":"119","author":"Sorkhou","year":"2024","journal-title":"Addiction"},{"key":"2026091810201104000_jech-2026-226050v1.9","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.1195","article-title":"Cognitive Outcomes of Young Children After Prenatal Exposure to Medications for Opioid Use Disorder: A Systematic Review and Meta-analysis","volume":"3","author":"Nelson","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2026091810201104000_jech-2026-226050v1.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-015-0438-5","article-title":"Erratum: neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis","volume":"15","author":"Baldacchino","year":"2015","journal-title":"BMC Psychiatry"},{"key":"2026091810201104000_jech-2026-226050v1.11","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14117"},{"key":"2026091810201104000_jech-2026-226050v1.12","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s00787-013-0511-x","article-title":"Is alcohol binge drinking in early and late pregnancy associated with behavioural and emotional development at age 7 years?","volume":"23","author":"Niclasen","year":"2014","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"2026091810201104000_jech-2026-226050v1.13","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.63.5.551"},{"key":"2026091810201104000_jech-2026-226050v1.14","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.6.1677"},{"key":"2026091810201104000_jech-2026-226050v1.15","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2024.839","article-title":"Examining the association between maternal prenatal psychiatric disorders and behavioural problems among offspring in early childhood: population-based study","volume":"11","author":"Braddon","year":"2025","journal-title":"BJPsych Open"},{"key":"2026091810201104000_jech-2026-226050v1.16","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s10803-020-04545-w","article-title":"Teacher-Reported Prevalence of FASD in Kindergarten in Canada: Association with Child Development and Problems at Home","volume":"51","author":"Pei","year":"2021","journal-title":"J Autism Dev Disord"},{"key":"2026091810201104000_jech-2026-226050v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2022.08.002"},{"key":"2026091810201104000_jech-2026-226050v1.18","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2016-2651","article-title":"Neonatal Abstinence Syndrome and High School Performance","volume":"139","author":"Oei","year":"2017","journal-title":"Pediatrics"},{"key":"2026091810201104000_jech-2026-226050v1.19","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S2352-4642(24)00076-2","article-title":"School performance in children with prenatal drug exposure and out-of-home care in NSW, Australia: a retrospective population-based cohort study","volume":"8","author":"Uebel","year":"2024","journal-title":"Lancet Child Adolesc Health"},{"key":"2026091810201104000_jech-2026-226050v1.20","doi-asserted-by":"publisher","DOI":"10.1177\/1077559520930818"},{"key":"2026091810201104000_jech-2026-226050v1.21","doi-asserted-by":"publisher","DOI":"10.1038\/S41591-020-1002-5"},{"key":"2026091810201104000_jech-2026-226050v1.22","doi-asserted-by":"publisher","DOI":"10.1111\/add.15629"},{"key":"2026091810201104000_jech-2026-226050v1.23","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu085"},{"key":"2026091810201104000_jech-2026-226050v1.24","unstructured":"Australian Bureau of Statistics . Snapshot of Australia: a picture of the economic, social and cultural make-up of Australia on Census Night. 2021."},{"key":"2026091810201104000_jech-2026-226050v1.25","unstructured":"Centre for Health Record Linkage (CHeReL) . Quality assurance. Sydney (AU) NSW Health. Available: https:\/\/www.cherel.org.au\/datasets"},{"key":"2026091810201104000_jech-2026-226050v1.26","unstructured":"Centre for Health Record Linkage (CHeReL) . Datasets. Sydney (AUG) NSW Health. Available: https:\/\/www.cherel.org.au\/quality-assurance"},{"key":"2026091810201104000_jech-2026-226050v1.27","doi-asserted-by":"publisher","DOI":"10.1037\/cjbs2007001"},{"key":"2026091810201104000_jech-2026-226050v1.28","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1080\/10409280701610812","article-title":"Investigating the validity of the Australian Early Development Index","volume":"18","author":"Brinkman","year":"2007","journal-title":"Early Education & Development"},{"key":"2026091810201104000_jech-2026-226050v1.29","unstructured":"Silburn S , Brinkman S , Ferguson-Hill S , et al . The Australian Early Development Index (AEDI) indigenous adaptation study. 2009."},{"key":"2026091810201104000_jech-2026-226050v1.30","unstructured":"Gregory T , Harman-Smith Y , Brinkman S . About the reliability and validity of the Australian version of the Early Development Instrument (AEDC fact sheet). Canberra (AU) Australian Government Department of Education; 2021. Available: https:\/\/www.aedc.gov.au\/docs\/default-source\/default-document-library\/aedc-fact-sheet---validity-and-reliability-of-the-avedi.pdf"},{"key":"2026091810201104000_jech-2026-226050v1.31","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1007\/s10578-023-01502-3","article-title":"Investigating the Validity of the Australian Early Development Census","volume":"55","author":"Howells","year":"2024","journal-title":"Child Psychiatry Hum Dev"},{"key":"2026091810201104000_jech-2026-226050v1.32","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2024-223439"},{"key":"2026091810201104000_jech-2026-226050v1.33","unstructured":"Australian Early Development Census . 2024 early development instrument questions. Canberra, Australia Australian Government Department of Education; 2024. Available: https:\/\/www.aedc.gov.au\/docs\/default-source\/resources\/2024-early-development-instrument-questions.pdf"},{"key":"2026091810201104000_jech-2026-226050v1.34","unstructured":"Australian Government Department of Education . Australian early development census national report 2024. Canberra ACT. Australian Government Department of Education; 2025."},{"key":"2026091810201104000_jech-2026-226050v1.35","unstructured":"Australian Bureau of Statistics . Disability, ageing and carers, Australia: summary of findings. Australian Bureau of Statistics, 2022."},{"key":"2026091810201104000_jech-2026-226050v1.36","unstructured":"Lawrence D , Johnson S , Hafekost J , et al . The mental health of children and adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Department of Health; 2015."},{"key":"2026091810201104000_jech-2026-226050v1.37","unstructured":"Australian Bureau of Statistics . Autism in Australia, 2022. Canberra: ABS, 2022."},{"key":"2026091810201104000_jech-2026-226050v1.38","article-title":"Use of administrative record linkage to measure medical and social risk factors for early developmental vulnerability in Ontario, Canada","volume":"6","author":"Saunders","year":"2021","journal-title":"Int J Popul Data Sci"},{"key":"2026091810201104000_jech-2026-226050v1.39","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1177\/0706743718816064","article-title":"Health, Social, Education, and Justice Outcomes of Manitoba First Nations Children Diagnosed with Fetal Alcohol Spectrum Disorder: A Population-Based Cohort Study of Linked Administrative Data","volume":"64","author":"Brownell","year":"2019","journal-title":"Can J Psychiatry"},{"key":"2026091810201104000_jech-2026-226050v1.40","first-page":"107","article-title":"Overrepresentation is not accidental: systemic racism in Australian child protection and out-of-home care systems","volume":"24","author":"Krakouer","year":"2023","journal-title":"Advances in Social Work & Welfare Education"},{"key":"2026091810201104000_jech-2026-226050v1.41","doi-asserted-by":"crossref","first-page":"106058","DOI":"10.1016\/j.chiabu.2023.106058","article-title":"Restoration from out-of-home care for Aboriginal children: Evidence from the pathways of care longitudinal study and experiences of parents and children","volume":"149","author":"Newton","year":"2024","journal-title":"Child Abuse Negl"},{"key":"2026091810201104000_jech-2026-226050v1.42","unstructured":"Coalition of Peaks . National agreement on closing the gap. Coalition of Peaks, 2020."},{"key":"2026091810201104000_jech-2026-226050v1.43","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.wombi.2022.04.007","article-title":"Identifying and dismantling racism in Australian perinatal settings: Reframing the narrative from a risk lens to intentionally prioritise connectedness and strengths in providing care to First Nations families","volume":"36","author":"Hine","year":"2023","journal-title":"Women Birth"},{"key":"2026091810201104000_jech-2026-226050v1.44","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1111\/dar.13477","article-title":"Community-based models of alcohol and other drug support for First Nations peoples in Australia: A systematic review","volume":"41","author":"Krakouer","year":"2022","journal-title":"Drug Alcohol Rev"},{"key":"2026091810201104000_jech-2026-226050v1.45","unstructured":"NSW Ministry of Health . NSW aboriginal health plan 2024\u20132034. St Leonards (AU): NSW Ministry of Health, 2024."},{"key":"2026091810201104000_jech-2026-226050v1.46","unstructured":"Australian Early Development Census . AEDC 2021 data story parent\u2019s and carer\u2019s guide to the AEDC: what works to improve outcomes for children? AEDC, 2021."},{"key":"2026091810201104000_jech-2026-226050v1.47","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1007\/s40429-021-00394-4","article-title":"\u201cA window of opportunity\u201d: parenting and addiction in the context of pregnancy","volume":"8","author":"Flykt","year":"2021","journal-title":"Curr Addict Rep"},{"key":"2026091810201104000_jech-2026-226050v1.48","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.chiabu.2011.10.007","article-title":"Integrated programs for mothers with substance abuse issues and their children: a systematic review of studies reporting on child outcomes","volume":"36","author":"Niccols","year":"2012","journal-title":"Child Abuse Negl"},{"key":"2026091810201104000_jech-2026-226050v1.49","doi-asserted-by":"crossref","first-page":"2877","DOI":"10.1007\/s10826-021-02099-8","article-title":"Integrated treatment programmes for mothers with substance use problems: a systematic review and meta-analysis of interventions to prevent out-of-home child placements","volume":"30","author":"Neo","year":"2021","journal-title":"J Child Fam Stud"},{"key":"2026091810201104000_jech-2026-226050v1.50","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/ije\/dyac092","article-title":"Emulating a target trial of intensive nurse home visiting in the policy-relevant population using linked administrative data","volume":"52","author":"Moreno-Betancur","year":"2023","journal-title":"Int J Epidemiol"},{"key":"2026091810201104000_jech-2026-226050v1.51","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003602","article-title":"Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis","volume":"18","author":"Jeong","year":"2021","journal-title":"PLoS Med"},{"key":"2026091810201104000_jech-2026-226050v1.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108341"},{"key":"2026091810201104000_jech-2026-226050v1.53","unstructured":"Stevens E , Gahan L . Improving the safety and wellbeing of vulnerable children: a consolidation of systemic recommendations and evidence. Southbank, Victoria: The Australian Institute of Family Studies, Commonwealth of Australia, 2024."},{"key":"2026091810201104000_jech-2026-226050v1.54","doi-asserted-by":"crossref","DOI":"10.1016\/j.midw.2019.102595","article-title":"Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: A qualitative study of midwives\u2019 experience","volume":"81","author":"Oni","year":"2020","journal-title":"Midwifery"},{"key":"2026091810201104000_jech-2026-226050v1.55","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1002\/ajs4.200","article-title":"Supporting Aboriginal and Torres Strait Islander Families to Stay Together from the Start (SAFeST Start): Urgent call to action to address crisis in infant removals","volume":"57","author":"Chamberlain","year":"2022","journal-title":"Aust J Soc Issues"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2026-226050","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:20:28Z","timestamp":1789752028000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2026-226050"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":55,"alternative-id":["10.1136\/jech-2026-226050"],"URL":"https:\/\/doi.org\/10.1136\/jech-2026-226050","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]}}}