Heroin abuse during pregnancy and its many associated environmental factors (e.g., lack of prenatal care) have been associated with adverse consequences including low birth weight, an important risk factor for later developmental delay. Methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse, although infants exposed to methadone during pregnancy typically require treatment for withdrawal symptoms. In the United States, several studies have found buprenorphine to be equally effective and as safe as methadone in the adult outpatient treatment of opioid dependence. Given this efficacy among adults, current studies are attempting to establish the safety and effectiveness of buprenorphine in opioid-dependent pregnant women. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with relative safety, although the likelihood of relapse to heroin use should be considered.