A randomized, double-blind, controlled trial compared buprenorphine and methadone for treating opioid dependence in pregnant women. The study involved 175 women across eight sites, with 131 completing the study. Neonates of mothers treated with buprenorphine required significantly less morphine for neonatal abstinence syndrome (NAS), had shorter hospital stays, and shorter NAS treatment durations compared to those of mothers treated with methadone. Buprenorphine was associated with fewer adverse events and similar maternal outcomes. However, more women in the buprenorphine group discontinued treatment due to dissatisfaction. Despite this, the results suggest that buprenorphine is an effective and safe alternative to methadone for treating opioid dependence in pregnancy. The study highlights the importance of comprehensive care and the need for further research to address treatment adherence and individual variability in response to medications. The findings support the use of buprenorphine as a first-line treatment for opioid dependence in pregnancy, with potential benefits in reducing NAS severity in neonates.A randomized, double-blind, controlled trial compared buprenorphine and methadone for treating opioid dependence in pregnant women. The study involved 175 women across eight sites, with 131 completing the study. Neonates of mothers treated with buprenorphine required significantly less morphine for neonatal abstinence syndrome (NAS), had shorter hospital stays, and shorter NAS treatment durations compared to those of mothers treated with methadone. Buprenorphine was associated with fewer adverse events and similar maternal outcomes. However, more women in the buprenorphine group discontinued treatment due to dissatisfaction. Despite this, the results suggest that buprenorphine is an effective and safe alternative to methadone for treating opioid dependence in pregnancy. The study highlights the importance of comprehensive care and the need for further research to address treatment adherence and individual variability in response to medications. The findings support the use of buprenorphine as a first-line treatment for opioid dependence in pregnancy, with potential benefits in reducing NAS severity in neonates.