TY - JOUR
T1 - Global trends in analgesic opioid use in pregnancy
T2 - A retrospective cohort study
AU - Brett, J.
AU - Cesta, C. E.
AU - Gillies, M. B.
AU - Bateman, B. T.
AU - Chan, A. Y.L.
AU - Cheng, M. C.Y.
AU - Cho, Y.
AU - Choi, E. Y.
AU - Cohen, J. M.
AU - Donald, S.
AU - Furu, K.
AU - Gissler, M.
AU - Gomes, T.
AU - Havard, A.
AU - Hernandez-Diaz, S.
AU - Hsieh, M. H.C.
AU - Huybrechts, K. F.
AU - Karlsson, P.
AU - Kelty, E.
AU - Lai, E. C.C.
AU - Ledlie, S.
AU - Wang, T.
AU - Leinonen, M. K.
AU - Parkin, L.
AU - Reutfors, J.
AU - Shin, J. Y.
AU - Su, C. T.T.
AU - Varney, B.
AU - Wong, I. C.K.
AU - Man, K. K.C.
AU - Zoega, H.
N1 - Publisher Copyright:
Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists.
PY - 2025/6/1
Y1 - 2025/6/1
N2 - Background: Pain is common during pregnancy yet there are few contemporary studies of opioid utilisation in pregnancy. We aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania [New South Wales (Australia), New Zealand], North America [Ontario (Canada), United States (US)], Northern Europe [Denmark, Finland, Iceland, Norway, Sweden, United Kingdom (UK)], and East Asia (Hong Kong, South Korea, Taiwan). Methods: We applied a common protocol to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy prior to birth in 2000-2020. Populations captured included those with public and private insurance in the US, a sample of primary care practices in the UK and whole-of-population cohorts in the remainder. We examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. We described use by sociodemographic- and pregnancy characteristics. Results: Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1000 in the UK to 191 per 1000 in the US publicly insured population. We observed the greatest relative decrease in prevalence in Hong Kong (prevalence ratio 0.2; 95% CI 0.1-0.2 between 2005 and 2020) and greatest increase in Iceland (prevalence ratio 4.4; 95% CI 3.7-5.2 between 2004 and 2017). Codeine and tramadol were among the three most prevalent opioids in most populations. In a sensitivity analysis defining opioid use as two or more opioid dispensing or prescribing events, the prevalence of opioid use across populations was 17 per 1000. Conclusions: In this large multinational study, we observed wide global variation in prevalence of analgesic opioid use in pregnancy, yet patterns of use by sociodemographic- and pregnancy characteristics were relatively consistent. Analgesic opioid use remained stable or downward trending over time in most, but not all, countries.
AB - Background: Pain is common during pregnancy yet there are few contemporary studies of opioid utilisation in pregnancy. We aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania [New South Wales (Australia), New Zealand], North America [Ontario (Canada), United States (US)], Northern Europe [Denmark, Finland, Iceland, Norway, Sweden, United Kingdom (UK)], and East Asia (Hong Kong, South Korea, Taiwan). Methods: We applied a common protocol to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy prior to birth in 2000-2020. Populations captured included those with public and private insurance in the US, a sample of primary care practices in the UK and whole-of-population cohorts in the remainder. We examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. We described use by sociodemographic- and pregnancy characteristics. Results: Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1000 in the UK to 191 per 1000 in the US publicly insured population. We observed the greatest relative decrease in prevalence in Hong Kong (prevalence ratio 0.2; 95% CI 0.1-0.2 between 2005 and 2020) and greatest increase in Iceland (prevalence ratio 4.4; 95% CI 3.7-5.2 between 2004 and 2017). Codeine and tramadol were among the three most prevalent opioids in most populations. In a sensitivity analysis defining opioid use as two or more opioid dispensing or prescribing events, the prevalence of opioid use across populations was 17 per 1000. Conclusions: In this large multinational study, we observed wide global variation in prevalence of analgesic opioid use in pregnancy, yet patterns of use by sociodemographic- and pregnancy characteristics were relatively consistent. Analgesic opioid use remained stable or downward trending over time in most, but not all, countries.
UR - http://www.scopus.com/inward/record.url?scp=85217918008&partnerID=8YFLogxK
U2 - 10.1097/ALN.0000000000005418
DO - 10.1097/ALN.0000000000005418
M3 - Article
C2 - 39946665
AN - SCOPUS:85217918008
SN - 0003-3022
VL - 142
SP - 1100
EP - 1113
JO - Anesthesiology
JF - Anesthesiology
IS - 6
ER -