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Abstract Body

Opioid use is a global problem of increasing magnitude. The cornerstone of the management of opioid use disorder during pregnancy involves opioid substitutes such as methadone therapy. Methadone freely crosses the placenta, potentially affecting fetal brain development at a critical time and emerging literature from preclinical and human studies suggest harm associated with prenatal opioid exposure.

Disentangling the myriad of environmental, social and health confounders inherent in pregnant mothers with opioid use disorder is one of the challenges when performing research in this field. A recent systematic review of literature reported worse neurodevelopmental outcomes in children after prenatal methadone exposure. Meta-analysis of 8 studies demonstrated lower point estimates of cognitive and motor function at 18-24 months in prenatal methadone exposure. Increased prevalence of visual, behavioural and language problems were also reported. However, the systematic review was limited by potential bias and high attrition rates.

Advanced MRI techniques such as diffusion MRI provide non-invasive detailed information about brain structure and quantitative measures which correlate to later neurodevelopmental outcome. Using these techniques, an MRI study performed on 40 term infants, 20 methadone exposed and 20 unexposed demonstrated early brain changes in the methadone exposed infants, who had less coherently organised white matter. A further MRI study reported accelerated brain maturation in prenatal drug exposure which may mediate the poorer neurodevelopmental outcome at 12 months. More research with pragmatic methodology is urgently needed to optimise the long term outcomes for mother-infant dyad affected by opioid use disorder.