A 29-year-old pregnant woman is referred to the psychiatric-mental health nurse practitioner for medication-assisted treatment (MAT) for opioid use disorder (OUD). Which of the following will the PMHNP prescribe?

Choice A reason: Naloxone is an opioid antagonist used primarily for emergency reversal of opioid overdose. It is not used as a maintenance medication in MAT, especially not during pregnancy, as it does not address withdrawal or cravings. Choice B reason: Naltrexone is also an opioid antagonist used in MAT, but it is contraindicated during pregnancy due to insufficient safety data and the risk of precipitating withdrawal. It requires complete detoxification before initiation, which is not ideal for pregnant patients. Choice C reason: Buprenorphine is a partial opioid agonist and is considered safe and effective for use during pregnancy. It reduces cravings and withdrawal symptoms without producing the same level of euphoria as full agonists. It is preferred over methadone in many cases due to lower risk of neonatal abstinence syndrome and better maternal outcomes. Choice D reason: Buprenorphine/Naloxone combination is generally avoided during pregnancy because naloxone can precipitate withdrawal in the fetus. Monotherapy with buprenorphine is the recommended approach for pregnant women with OUD.