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Addiction during pregnancy contributes to maternal and infant morbidity including pre-term deliveries, low birth weight, neonatal withdrawal, lengthy neonatal intensive care and infant mortality. Combined use of pharmacological and behavioral treatment approaches in managing pregnant opioid-dependent women has been shown to be beneficial for improving treatment retention and reducing maternal drug use. Clinicians should understand the complex biopsychosocial factors that make the treatment of opioid-dependent pregnant women a challenge as well as the principles and the differences in using methadone or buprenorphine combined with behavioral treatment. Researchers should consider continued studies on the use of methadone during pregnancy, relationship of maternal dose and neonatal abstinence, the differences between methadone and buprenorphine, and the impact of pharmacological options on patients and treatment providers.