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Updated: Apr 17, 2026

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Prenatal exposure to buprenorphine or methadone and adverse neurodevelopmental outcomes: population based cohort

Sabine Friedrich1,2, Krista F Huybrechts3,2, Loreen Straub3

  • 1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA h4p@bwh.harvard.edu.

BMJ (Clinical Research Ed.)
|April 15, 2026
PubMed

Insights

Prenatal exposure to buprenorphine and methadone showed similar rates of neurodevelopmental disorders in children. This research supports buprenorphine as a safe treatment for opioid use disorder during pregnancy.

Area of Science:

  • Perinatal mental health
  • Neurodevelopmental outcomes
  • Pharmacological interventions for opioid use disorder

Background:

  • Opioid use disorder (OUD) during pregnancy presents significant challenges for maternal and infant health.
  • Buprenorphine and methadone are common pharmacotherapies for OUD, but their long-term neurodevelopmental effects require careful evaluation.
  • Understanding the comparative safety profiles of these medications is crucial for clinical decision-making.

Purpose of the Study:

  • To compare the incidence of neurodevelopmental disorders in children exposed prenatally to buprenorphine versus methadone.
  • To assess the long-term neurodevelopmental outcomes associated with different prenatal medication exposures for opioid use disorder.

Main Methods:

  • A population-based cohort study utilizing US nationwide Medicaid data from 2000 to 2018.
  • Inclusion of over 18,000 pregnancies exposed to buprenorphine or methadone.
  • Kaplan-Meier and Cox proportional hazards regression analyses, with propensity score overlap weighting to control for confounding factors.

Main Results:

  • Crude cumulative incidence of neurodevelopmental disorders by age 8 was similar: 34% for buprenorphine and 33% for methadone.
  • Adjusted analyses indicated slightly lower hazards for any neurodevelopmental disorder with buprenorphine versus methadone (aHR 0.81).
  • Prevalent use of buprenorphine was associated with significantly lower hazards (aHR 0.62), while treatment initiation during pregnancy showed no difference (aHR 1.13).

Conclusions:

  • Prenatal exposure to buprenorphine does not appear to increase the risk of long-term adverse neurodevelopmental outcomes compared to methadone.
  • Findings support buprenorphine as a safe and effective treatment option for opioid use disorder in pregnant individuals.
  • Further research may explore nuances related to timing of treatment initiation and medication prevalence.
Abstract

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