This invited commentary discusses the importance of shared decision-making when selecting medication treatment for opioid use disorder during pregnancy. Responding to a large observational study comparing congenital malformations after prenatal buprenorphine and methadone exposure, the authors emphasize that differences in particular birth outcomes should be interpreted alongside the well-established importance of continuing effective opioid use disorder treatment. They argue that patient preferences, treatment access, clinical circumstances, and the risks of untreated opioid use disorder belong in individualized discussions. The commentary does not report a new clinical trial.
