The prevalence of opioid abuse in the United States has been steadily increasing 
over the last several years among many major demographics, including pregnant 
women. Rise in prenatal opioid abuse has resulted in subsequent escalation of 
neonatal abstinence syndrome incidence, prompting the US Congress to pass the 
Protecting Our Infants Act of 2015. This act specifically calls for a critical 
review of current treatment options for prenatal opioid abuse which may 
ultimately lead to the development of better therapies and a decreased incidence 
of neonatal abstinence syndrome. Currently, the American College of 
Obstetricians and Gynecologists recommends methadone, buprenorphine, or 
buprenorphine/naloxone in the treatment of prenatal opioid abuse. In this 
review, each maintenance therapy treatment option is discussed and compared 
revealing inconsistencies in postpartum retention rates, effects on fetal 
development, and availability to patients due to restrictions in health care 
coverage. Although each of these treatment options reduces opioid abuse and 
potential negative outcomes for the fetus, the shortcomings of these drugs 
highlight the overarching need for an improved standard of care. Drug developers 
and lawmakers should consider that affordability, coverage by health insurance, 
and success in retention rates substantially impacts the decision of the patient 
and healthcare provider regarding utilization of a particular opioid maintenance 
therapy.