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Opioids and the developing brain: time to rethink perinatal care for infants of opioid-dependent mothers
  1. James P Boardman1,2,
  2. Helen Mactier3,4,
  3. Lori A Devlin5
  1. 1 MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
  2. 2 Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
  3. 3 Neonatology, Princess Royal Maternity, Glasgow, UK
  4. 4 Princess Royal Maternity, University of Glasgow, Glasgow, UK
  5. 5 Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to Professor James P Boardman, MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK; james.boardman{at}


Illicit use of opioids is a global health crisis with major implications for women and children. Strategies for managing opioid use disorder (OUD) in pregnancy have been tested over the past 40 years, but studies have focused on maternal and pregnancy outcomes, with less attention given to long-term follow-up of exposed children. Here, we provide a narrative review of recent advances in the assessment and management of neonatal opioid withdrawal syndrome (NOWS), and we summarise evidence from multiple domains—neuroimaging, electrophysiology, visual development and function, neurodevelopment, behaviour, cognition and education—which suggests that prenatal opioid exposure modifies child development. Further studies are required to determine the optimal management of pregnant women with OUD and babies with NOWS. We identify knowledge gaps and suggest that future study designs should evaluate childhood outcomes, including infant brain development and long-term neurocognitive and visual function.

  • neonatology
  • neurology

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  • Twitter @JamesPeterBoar2, @HMactier

  • Contributors JPB drafted the review outline. JPB, HM and LD contributed equally to subsequent drafts. All authors approved the final version.

  • Funding JPB undertook this work in the Medical Research Council Centre for Reproductive Health, which is funded by a Medical Research Council Centre grant (Medical Research Council G1002033).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.