Impact of Maternal Opioid Use During Pregnancy on Offspring Brain Structure and Function: A Systematic Review of Magnetic Resonance Imaging Studies Publisher Pubmed



Karimi E ; Safari Sabet A ; Parsaei M ; Mohammadian SM ; Hantoushzadeh S ; Peterson BS
Source: Journal of Clinical Neuroscience Published:2026

Abstract

Background Prenatal opioid exposure has been increasingly recognized as a public health concern due to its potential to disrupt fetal brain development. This study aims to synthesize current magnetic resonance imaging (MRI) evidence on the neurodevelopmental effects of prenatal opioid exposure in offspring. Methods A systematic search was performed across PubMed, Embase, Web of Science, and Scopus on December 4, 2024. We aimed to include all peer-reviewed articles comparing structural MRI, diffusion tensor imaging (DTI), or functional MRI (fMRI) measurements between offspring exposed to opioids and non-exposed controls. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the certainty of evidence. Results A total of 25 studies were included, of which 12 studies used anatomical MRI, six used DTI, and seven used fMRI; some used multiple modalities. Structural MRI studies reported reduced total and regional brain volumes (e.g., frontal lobe, amygdala, basal ganglia). DTI studies revealed lower fractional anisotropy and increased diffusivity in major white matter tracts. fMRI studies showed altered connectivity in the visual and default mode networks. GRADE assessments indicated moderate certainty for reduced amygdala and frontal lobe volumes, as well as frontal cortical surface area; however, other findings had low certainty due to small samples and methodological heterogeneity. Conclusions Our findings suggested that prenatal opioid exposure is associated with widespread alterations in brain structure and connectivity. Future studies should employ standardized imaging, longitudinal methodologies, and precise exposure timing to enhance comprehension of developmental trajectories. © 2026 Elsevier Ltd.