This is a review of the literature regarding the clinical management of pregnant women maintained on methadone treatment. The prevalence of opiate use, definition of opiate dependence, common concerns regarding methadone use in pregnancy, and maternal/fetal harm are addressed. Recommendations for nurses are synthesized from the clinical literature, clinical experiences, and the empirical literature. These recommendations address: antepartum issues including treatment, dosage and pharmacological considerations, medical conditions and lab tests, intrapartum issues, postpartum concerns including breastfeeding, neonatal withdrawal, and developmental effects associated with methadone.