Prenatal Opioid Exposure is Associated with Punctate White Matter Lesions in Term Newborns.

Objective: To assess whether prenatal opioid exposure is associated with punctate white matter lesions (PWML) on brain magnetic resonance imaging (MRI) in a large prospective cohort of term newborns.

Methods: Newborns ≥37 weeks' gestation with prenatal opioid exposure and unexposed controls underwent brain MRI at 0-1 months of age in the prospective observational Outcomes of Babies with Opioid Exposure (OBOE) study. Exposure status was based on maternal self-report and/or maternal or neonatal toxicology screening. MRIs were scored by two pediatric neuroradiologists masked to exposure. Multinomial logistic regression was used to compute odds ratios for PWML by opioid exposure, adjusting for various confounders.

Results: Opioid-exposed newborns (n=165) had lower birth weight and smaller head circumference and were more likely to have mothers who smoked, were positive for hepatitis C, and had limited education than unexposed neonates (n=94). 27% of exposed newborns had 1 or more PWML compared with 13% of unexposed newborns (P = .031). After adjusting for covariates, opioid exposure was associated with higher odds of PWML (adjusted odds ratio [aOR] 2.68, 95% CI 1.07-6.72, P = .04), with methadone exposure worse than buprenorphine and other opioids (aOR 3.25, 95% CI 1.21-8.75, P=.02).

Conclusions: Prenatal opioid exposure is associated with an increased risk of PWML in newborns, with methadone exposure significantly worse than buprenorphine. As PWML are associated with adverse neurologic outcomes in other populations, follow-up will evaluate if these lesions significantly impact neurodevelopmental outcomes.