Gestational Opioid Exposure: From Morphine to MOUD - How Opioids Impact Offspring Development and Maternal Care

Opioid use disorder (OUD) continues to be a global problem, with particularly high opioid usage rates in the United States. One major contributor to this crisis has been the high rate of opioid prescriptions, which has increased access to opioids and contributed to many vulnerable individuals becoming dependent or addicted. Many of these affected people are women of reproductive age, which in turn results in many women using or abusing opioids during pregnancy and thus many infants being exposed to illicit opioids. OUD is typically treated with either methadone or buprenorphine (BUP), two effective opioid-based medications for OUD (MOUD). BUP has recently gained more attention and replaced methadone as the "gold standard" of treatment since its unique pharmacodynamic properties seem to result in better compliance, less withdrawal symptoms, and improved infant outcomes compared to methadone. However, the effects of BUP exposure on the long-term outcome of the offspring and mother-infant dyad are not fully understood. This chapter will review the current state of the literature regarding effects of gestational opioid exposure on offspring outcomes, focusing on morphine as a commonly used illicit substance and BUP as a widely used MOUD. Collectively, the literature reviewed here highlights the need for future research into the impact of gestational opioid use on mothers, their care behavior, and their subsequent mother-infant bonds.