Archives of Women's Mental Health

, Volume 17, Issue 6, pp 529–539

Characteristics and quality of life of opioid-dependent pregnant women in Austria

  • Verena E. Metz
  • Sandra D. Comer
  • Johanna Wuerzl
  • Anna Pribasnig
  • Gabriele Fischer
Original Article


This study investigated pregnant opioid-dependent women undergoing maintenance therapy, applying a multidisciplinary, case-management approach at the Addiction Clinic of the Medical University of Vienna, Austria. It aimed at characterizing the patients’ basic demographic and clinical parameters and evaluating their overall quality of life (QoL) prepartum and postpartum. Three hundred ninety women were treated between 1994 and 2009 with buprenorphine (n = 77), methadone (n = 184), or slow-release oral morphine (SROM) (n = 129) on an outpatient basis throughout their pregnancy and postpartum period. All patients were subject to standardized prepartum and postpartum medical and psychiatric assessments, including QoL assessments using a German adaptation of the Lancashire QoL Profile (Berliner Lebensqualitaetsprofil), and regular supervised urine toxicologies. No medication group differences were revealed regarding basic demographic or clinical data. Mean maintenance doses (SD) at time of delivery were as follows: 64 mg (36 mg) methadone, 10 mg (6 mg) buprenorphine, 455 mg (207 mg) SROM. However, buprenorphine-medicated women showed significantly less concomitant benzodiazepine consumption than methadone- or SROM-maintained women (p = 0.005), and significantly less concomitant opioid consumption than methadone-maintained women (p = 0.033) during the last trimester. Overall QoL was good prepartum and postpartum in all measured domains except “finances” and “prospect of staying in the same housing situation,” and no differences were observed in QoL among the three medication groups (p = 0.177). QoL improved significantly after delivery in most of the domains (p < 0.001). Although opioid-dependent pregnant women face high-risk pregnancies and show variability in addiction severity, they report good QoL independent of the medication administered. These results show that individually tailored treatment interventions are effective for this patient population and suggest a QoL improvement after delivery.


Opioid dependence Pregnancy Opioid maintenance treatment Quality of life 


  1. American Psychiatric Association (1994) Diagnostic and statistical manual of mental health disorders (4th ed). American Psychiatric Association, WashingtonGoogle Scholar
  2. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed). APA, WashingtonGoogle Scholar
  3. Armstrong D, Caldwell D (2004) Origins of the concept of quality of life in health care: a rhetorical solution to a political problem. Social Theory and Health 2:361–371Google Scholar
  4. Bakstad B, Sarfi M, Welle-Strand GK, Ravndal E (2009) Opioid maintenance treatment during pregnancy: occurrence and severity of neonatal abstinence syndrome. A national prospective study. Eur Addict Res 15(3):128–134Google Scholar
  5. Bartu AE, Ilett KF, Hackett LP, Doherty DA, Hamilton D (2012) Buprenorphine exposure in infants of opioid-dependent mothers at birth. Aust N Z J Obstet Gynaecol 52(4):342–347PubMedCrossRefGoogle Scholar
  6. Best D, Savic M, Beckwith M, Honor S, Karpusheff J, Lubman DI (2013) The role of abstinence and activity in the quality of life of drug users engaged in treatment. J Subst Abuse Treat 45(3):273–279PubMedCrossRefGoogle Scholar
  7. Daley M, Shepard DS, Bury-Maynard D (2005) Changes in quality of life for pregnant women in substance user treatment: developing a quality of life index for the addictions. Subst Use Misuse 40(3):375–394PubMedCrossRefGoogle Scholar
  8. De Maeyer J, Vanderplasschen W, Lammertyn J, van Nieuwenhuizen C, Sabbe B, Broekaert E (2011) Current quality of life and its determinants among opiate-dependent individuals five years after starting methadone treatment. Qual Life Res 20(1):139–150PubMedCentralPubMedCrossRefGoogle Scholar
  9. De Maeyer J, van Nieuwenhuizen C, Bongers IL, Broekaert E, Vanderplasschen W (2013) Profiles of quality of life in opiate-dependent individuals after starting methadone treatment: a latent class analysis. Int J Drug Policy 24(4):342–350PubMedCrossRefGoogle Scholar
  10. Dryden C, Young D, Hepburn M, Mactier H (2009) Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG 116(5):665–71PubMedCrossRefGoogle Scholar
  11. Fischer G, Eder H, Peternell A, Windhaber J (2000) Lebensqualitaet gravider substanzabhaengiger Frauen unter oraler Erhaltungstherapie mit synthetischen Opioiden. Nervenheilkunde 19: 205-11 (German)Google Scholar
  12. Fischer G, Ortner R, Rohrmeister K, Jagsch R, Baewert A, Langer M, Aschauer H (2006) Methadone versus buprenorphine in pregnant addicts: a double-blind, double-dummy comparison study. Addiction 101(2):275–281PubMedCrossRefGoogle Scholar
  13. Giacomuzzi SM, Riemer Y, Ertl M, Kemmler G, Richter R, Rössler H, Hinterhuber H (2001) Substitutionsbehandlung und Lebensqualität: Methadon vs. retardiertesMorphinsulfat—eineVergleichsstudie. Suchtmed 3(1):89–95Google Scholar
  14. Giacomuzzi SM, Riemer Y, Ertl M, Kemmler G, Rössler H, Hinterhuber H, Kurz M (2003) Buprenorphine versus methadone maintenance treatment in an ambulant setting: a health-related quality of life assessment. Addiction 98(5):693–702PubMedCrossRefGoogle Scholar
  15. Giacomuzzi S, Kemmler G, Ertl M, Riemer Y (2006) Opioid addicts at admission vs. slow-release oral morphine, methadone, and sublingual buprenorphine maintenance treatment participants. Subst Use Misuse 41(2):223–244PubMedCrossRefGoogle Scholar
  16. Jones HE (2013) Treating opioid use disorders during pregnancy: historical, current, and future directions. Subst Abus 34(2):89–91PubMedCrossRefGoogle Scholar
  17. Jones HE, Johnson RE, Jasinski DR, O'Grady KE, Chisholm CA, Choo RE, Crocetti M, Dudas R, Harrow C, Huestis MA, Jansson LM, Lantz M, Lester BM, Milio L (2005) Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome. Drug Alcohol Depend 79(1):1–10PubMedCrossRefGoogle Scholar
  18. Jones HE, Kaltenbach K, Heil SH, Stine SM, Coyle MG, Arria AM, O’Grady KE, Selby P, Martin PR, Fischer G (2010) Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med 363(24):2320–2331PubMedCentralPubMedCrossRefGoogle Scholar
  19. Kashiwagi M, Arlettaz R, Lauper U, Zimmermann R, Hebisch G (2005) Methadone maintenance program in a Swiss perinatal center: (I): Management and outcome of 89 pregnancies. Acta Obstet Gynecol Scand 84(2):140–144PubMedCrossRefGoogle Scholar
  20. Katschnig H (2006) Quality of life in mental disorders: challenges for research and clinical practice. World Psychiatry 5(3):139–145PubMedCentralPubMedGoogle Scholar
  21. Laudet AB (2011) The case for considering quality of life in addiction research and clinical practice. Addict Sci Clin Pract 6(1):44–55PubMedCentralPubMedGoogle Scholar
  22. Mayet S, Groshkova T, Morgan L, MacCormack T, Strang J (2008) Drugs and pregnancy—outcomes of women engaged with a specialist perinatal outreach addictions service. Drug Alcohol Rev 27(5):497–503PubMedCrossRefGoogle Scholar
  23. McCarthy JJ, Leamon MH, Parr MS, Anania B (2005) High-dose methadone maintenance in pregnancy: maternal and neonatal outcomes. Am J Obstet Gynecol 193(3 Pt 1):606–610PubMedCrossRefGoogle Scholar
  24. McLellan AT, Luborsky L, O’Brien CP, Woody GE (1980) An improved diagnostic instrument for substance abuse patients: the Addiction Severity Index. J Nerv Ment Dis 168:26–33PubMedCrossRefGoogle Scholar
  25. Oliver JPJ (1991/1992)The social care directive: development of a quality of life profile for use in community services for the mentally ill. Soc Work SocSci Rev 3:5-45Google Scholar
  26. Osborn DA, Jeffery HE, Cole MJ (2010) Opiate treatment for opiate withdrawal in newborn infants. Cochrane Database Syst Rev 6(10):CD002059Google Scholar
  27. Passey M, Sheldrake M, Leitch K, Gilmore V (2007) Impact of case management on rural women's quality of life and substance use. Rural Remote Health 7(3):710PubMedGoogle Scholar
  28. Priebe S, Gruyters T, Heinze M, Hoffmann C, Jaekel A (1995) Subjective evaluation criteria in psychiatric care—assessment methods for research and general practice. Psychiatr Prax 22(4):140–44, GermanPubMedGoogle Scholar
  29. Schindler S, Ortner R, Fischer G (2002) Medizinische Grundlagenzur Therapie der Opiatabhängigkeit. In: Fischer G (ed) Therapiemit Opioiden. Wien. Facultas Universitätsverlag, Germany, pp 31–77Google Scholar
  30. Schwarz N, Clore GL (1983) Mood, misattribution, and judgments of well-being: informative and directive functions of affective states. J Personal Soc Psychol 45:513–523CrossRefGoogle Scholar
  31. Seligman NS, Salva N, Hayes EJ, Dysart KC, Pequignot EC, Baxter JK (2008) Predicting length of treatment for neonatal abstinence syndrome in methadone-exposed neonates. Am J Obstet Gynecol 199(4):396–e1-7PubMedCrossRefGoogle Scholar
  32. Seligman NS, Almario CV, Hayes EJ, Dysart KC, Berghella V, Baxter JK (2010) Relationship between maternal methadone dose at delivery and neonatal abstinence syndrome. J Pediatr 157(3):428–433, 433.e1Google Scholar
  33. Shainker SA, Saia K, Lee-Parritz A (2012) Opioid addiction in pregnancy. Obstet Gynecol Surv 67(12):817–825PubMedGoogle Scholar
  34. Simmat-Durand L, Lejeune C, Gourarier L, Groupe d’ Etudes Grossesseet Addictions (GEGA) (2009) Pregnancy under high-dose buprenorphine. Eur J Obstet Gynecol Reprod Biol 142(2):119–123PubMedCrossRefGoogle Scholar
  35. Slade M, Leese M, Ruggeri M, Kuipers E, Tansella M, Thornicroft G (2004) Does meeting needs improve quality of life? Psychother Psychosom 73(3):183–189PubMedCrossRefGoogle Scholar
  36. Statistik Austria (2011a) DurchschnittlichesGebaer- bzw.Fertilitaetsalter der Mutter nachLebendgeburtenfolgeseit 1991; 2011a [updated 2011 May 19; accessed 2011, June 3]. Available from: German
  37. Statistik Austria (2011b) Geboreneseit 2000 nachausgewaehltendemografischen und medizinischenMerkmalen [updated 2011 May 19; accessed 2011, June 3]. Available from: German
  38. WHO Division of Mental Health Prevention of Substance Abuse (1998) WHOQOL User Manual. WHO, Geneva, SwitzerlandGoogle Scholar
  39. Unger A, Metz V, Fischer G (2012) Opioid dependent and pregnant: what are the best options for mothers and neonates?ObstetGynecol Int. 2012:195954Google Scholar
  40. Vucinovic M, Roje D, Vucinovic Z, Capkun V, Bucat M, Banovic I (2008) Maternal and neonatal effects of substance abuse during pregnancy: our ten-year experience. Yonsei Med J 49(5):705–713PubMedCentralPubMedCrossRefGoogle Scholar
  41. Welle-Strand GK, Skurtveit S, Jones HE, Waal H, Bakstad B, Bjarkø L, Ravndal E (2013) Neonatal outcomes following in utero exposure to methadone or buprenorphine: a National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009. Drug Alcohol Depend 127(1–3):200–206PubMedCrossRefGoogle Scholar
  42. Westin AA, Huestis MA, Aarstad K, Spigset O (2009) Short communication: urinary excretion of 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol in a pregnant woman following heavy, chronic cannabis use. J Anal Toxicol 33(9):610–614PubMedCrossRefGoogle Scholar
  43. Winklbaur B, Jagsch R, Ebner N, Thau K, Fischer G (2008) Quality of life in patients receiving opioid maintenance therapy. A comparative study of slow-release morphine versus methadone treatment. Eur Addict Res 14(2):99–105PubMedCrossRefGoogle Scholar
  44. Winklbaur B, Baewert A, Jagsch R, Rohrmeister K, Metz V, AeschbachJachmann C, Thau K, Fischer G (2009) Association between prenatal tobacco exposure and outcome of neonates born to opioid-maintained mothers. Implications for treatment. Eur Addict Res 15(3):150–156PubMedCrossRefGoogle Scholar
  45. WMA (1964-2008) The Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects. Accessed 30 July 2013

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Verena E. Metz
    • 1
    • 2
  • Sandra D. Comer
    • 1
  • Johanna Wuerzl
    • 2
  • Anna Pribasnig
    • 2
  • Gabriele Fischer
    • 2
    • 3
  1. 1.Department of PsychiatryColumbia University and NYSPINew YorkUSA
  2. 2.Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
  3. 3.Center for Public HealthMedical University of ViennaViennaAustria

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