Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study

Jonathan Brett; Carolyn E. Cesta; Malcolm B. Gillies; Brian T. Bateman; Adrienne Y.L. Chan; Michael C.Y. Cheng; Yongtai Cho; Eunyoung Choi; Jacqueline M. Cohen; Sarah Donald; Kari Furu; Mika Gissler; Tara Gomes; Alice Havard; Sonya Hernandez-Diaz; Miyuki H.C. Hsieh; Krista F. Huybrechts; Par Karlsson; Erin Kelty; Edward C.C. Lai; Shaleesa Ledlie; Tianru Wang; Maarit K. Leinonen; Lianne Parkin; Johan Reutfors; Jo-Young Shin; Chris T.T. Su; Bianca Varney; Ian C.K. Wong; Kenneth K.C. Man; Helga Zoega

doi:10.1097/ALN.0000000000005418

Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study

Jonathan Brett^*
, Carolyn E. Cesta
, Malcolm B. Gillies
, Brian T. Bateman
, Adrienne Y.L. Chan
, Michael C.Y. Cheng
, Yongtai Cho
, Eunyoung Choi
, Jacqueline M. Cohen
, Sarah Donald
, Kari Furu
, Mika Gissler
, Tara Gomes
, Alice Havard
, Sonya Hernandez-Diaz
, Miyuki H.C. Hsieh
, Krista F. Huybrechts
, Par Karlsson
, Erin Kelty
, Edward C.C. Lai

Shaleesa Ledlie, Tianru Wang, Maarit K. Leinonen, Lianne Parkin, Johan Reutfors, Jo-Young Shin, Chris T.T. Su, Bianca Varney, Ian C.K. Wong, Kenneth K.C. Man, Helga Zoega

^*Corresponding author for this work

University of New South Wales, Australia
Karolinska Institutet
Stanford University School of Medicine
National Cheng Kung University College of Medicine
Sungkyunkwan University
Norwegian Institute of Public Health
University of Otago
Finnish Institute for Health and Welfare
Academic Primary Health Care Centre
St. Michael's Hospital, Toronto
University of Toronto
Institute for Clinical Evaluative Sciences
National Drug and Alcohol Research Centre
Harvard University
Helsingin yliopisto
University of Hong Kong
Laboratory of Data Discovery for Health
University of London
University of Iceland

Research output: Contribution to journal › Article › peer-review

3 Citations (SciVal)

7 Downloads (Pure)

Abstract

Background: Pain is common during pregnancy, yet there are few contemporary studies of opioid use in pregnancy. This study aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania (New South Wales, Australia, and New Zealand), North America (Ontario, Canada, and United States), Northern Europe (Denmark, Finland, Iceland, Norway, Sweden, and United Kingdom), and East Asia (Hong Kong, South Korea, and Taiwan). Methods: A common protocol was applied to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy before birth in 2000 to 2020. The populations captured included those with public and private insurance in the United States, a sample of primary care practices in the United Kingdom, and whole-of-population cohorts in the remainder of the locations. This study examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. Use by sociodemographic and pregnancy characteristics is described. Results: Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1,000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1,000 in the United Kingdom to 191 per 1,000 in the U.S. publicly insured population. The greatest relative decrease in prevalence was observed in Hong Kong (prevalence ratio, 0.2; 95% CI, 0.1 to 0.2 between 2005 and 2020), and the greatest increase was in Iceland (prevalence ratio, 4.4; 95% CI, 3.7 to 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 1,000. conclusions: In this large multinational study, wide global variation in the prevalence of analgesic opioid use in pregnancy was observed, 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.

Original language	English
Pages (from-to)	1100-1113
Number of pages	14
Journal	Anesthesiology
Volume	142
Issue number	6
Early online date	13 Feb 2025
DOIs	https://doi.org/10.1097/ALN.0000000000005418
Publication status	Published - Jun 2025

Bibliographical note

Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists. This is an open-access article distributed
under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work
provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Funding

Supported by National Health and Medical Research Council Center of Research Excellence in Medications Intelligence (Canberra, Australia) grant No. 1196900 and National Health and Medical Research Council investigator grant No. 1196560 (to Dr. Brett) and by a University of New South Wales Scientia Program Award (to Dr. Zoega). Supported in part by Institute for Clinical Evaluative Sciences (Ontario, Canada), which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care, and by the Research Council of Norway through Centers of Excellence funding scheme project No. 262700. Also supported by Taiwan National Science and Technology Council grant No. 112-2628-B-006-003, Taiwan National Health Research Institutes grant No. NHRI-11A1-CG-CO-04-2225-1, and funds from the Taiwan Health and Welfare Data Science Center. Dr. Kelty has received funding from Medical Development International (Scoresby, Australia), and Dr. Leinonen has received funding from Innovative Medicines Initiative (Brussels, Belgium). Dr. Wong receives payment for work with the Institute for Health Research in England, the European Commission, the National Health and Medical Research Council in Australia, the European Union’s Seventh Framework program for research and technological development, the Research Grants Council Hong Kong, and the Health and Medical Research Fund Hong Kong; receives consulting fees from the World Health Organization (Geneva, Switzerland); receives payment for expert testimony for appeal court in Hong Kong; serves on advisory committees for Member of Pharmacy and Poisons Board (Hong Kong); is a member of the Expert Committee on Clinical Events Assessment Following COVID-19 Immunization; and is a member of the Advisory Panel on COVID-19 Vaccines of the Hong Kong Government. Dr. Man is funded by a C.W. Maplethorpe Fellowship, European Commission Horizon 2020, National Institute for Health and Care Research (United Kingdom), and the Hong Kong Research Grant Council.

Keywords

Adult
Analgesics, Opioid/therapeutic use
Cohort Studies
Drug Prescriptions/statistics & numerical data
Female
Global Health
Humans
Internationality
Pain/drug therapy
Practice Patterns, Physicians'
Pregnancy
Pregnancy Complications/drug therapy
Retrospective Studies
Young Adult

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10.1097/ALN.0000000000005418Licence: CC BY-NC-ND 4.0

global_trends_in_analgesic_opioid_use_in_pregnancy
Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Final published version, 896 KBLicence: CC BY-NC-ND 4.0

Cite this

Brett, J., Cesta, C. E., Gillies, M. B., Bateman, B. T., Chan, A. Y. L., Cheng, M. C. Y., Cho, Y., Choi, E., Cohen, J. M., Donald, S., Furu, K., Gissler, M., Gomes, T., Havard, A., Hernandez-Diaz, S., Hsieh, M. H. C., Huybrechts, K. F., Karlsson, P., Kelty, E., ... Zoega, H. (2025). Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study. Anesthesiology, 142(6), 1100-1113. https://doi.org/10.1097/ALN.0000000000005418

@article{b061a833f1d74bbfbd6b7b14ca4ded96,

title = "Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study",

abstract = "Background: Pain is common during pregnancy, yet there are few contemporary studies of opioid use in pregnancy. This study aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania (New South Wales, Australia, and New Zealand), North America (Ontario, Canada, and United States), Northern Europe (Denmark, Finland, Iceland, Norway, Sweden, and United Kingdom), and East Asia (Hong Kong, South Korea, and Taiwan). Methods: A common protocol was applied to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy before birth in 2000 to 2020. The populations captured included those with public and private insurance in the United States, a sample of primary care practices in the United Kingdom, and whole-of-population cohorts in the remainder of the locations. This study examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. Use by sociodemographic and pregnancy characteristics is described. Results: Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1,000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1,000 in the United Kingdom to 191 per 1,000 in the U.S. publicly insured population. The greatest relative decrease in prevalence was observed in Hong Kong (prevalence ratio, 0.2; 95\% CI, 0.1 to 0.2 between 2005 and 2020), and the greatest increase was in Iceland (prevalence ratio, 4.4; 95\% CI, 3.7 to 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 1,000. conclusions: In this large multinational study, wide global variation in the prevalence of analgesic opioid use in pregnancy was observed, 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.",

keywords = "Adult, Analgesics, Opioid/therapeutic use, Cohort Studies, Drug Prescriptions/statistics \& numerical data, Female, Global Health, Humans, Internationality, Pain/drug therapy, Practice Patterns, Physicians', Pregnancy, Pregnancy Complications/drug therapy, Retrospective Studies, Young Adult",

author = "Jonathan Brett and Cesta, \{Carolyn E.\} and Gillies, \{Malcolm B.\} and Bateman, \{Brian T.\} and Chan, \{Adrienne Y.L.\} and Cheng, \{Michael C.Y.\} and Yongtai Cho and Eunyoung Choi and Cohen, \{Jacqueline M.\} and Sarah Donald and Kari Furu and Mika Gissler and Tara Gomes and Alice Havard and Sonya Hernandez-Diaz and Hsieh, \{Miyuki H.C.\} and Huybrechts, \{Krista F.\} and Par Karlsson and Erin Kelty and Lai, \{Edward C.C.\} and Shaleesa Ledlie and Tianru Wang and Leinonen, \{Maarit K.\} and Lianne Parkin and Johan Reutfors and Jo-Young Shin and Su, \{Chris T.T.\} and Bianca Varney and Wong, \{Ian C.K.\} and Man, \{Kenneth K.C.\} and Helga Zoega",

note = "Copyright {\textcopyright} 2025 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.",

year = "2025",

month = jun,

doi = "10.1097/ALN.0000000000005418",

language = "English",

volume = "142",

pages = "1100--1113",

journal = "Anesthesiology",

issn = "0003-3022",

publisher = "Lippincott Williams and Wilkins",

number = "6",

}

Brett, J, Cesta, CE, Gillies, MB, Bateman, BT, Chan, AYL, Cheng, MCY, Cho, Y, Choi, E, Cohen, JM, Donald, S, Furu, K, Gissler, M, Gomes, T, Havard, A, Hernandez-Diaz, S, Hsieh, MHC, Huybrechts, KF, Karlsson, P, Kelty, E, Lai, ECC, Ledlie, S, Wang, T, Leinonen, MK, Parkin, L, Reutfors, J, Shin, J-Y, Su, CTT, Varney, B, Wong, ICK, Man, KKC & Zoega, H 2025, 'Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study', Anesthesiology, vol. 142, no. 6, pp. 1100-1113. https://doi.org/10.1097/ALN.0000000000005418

TY - JOUR

T1 - Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study

AU - Brett, Jonathan

AU - Cesta, Carolyn E.

AU - Gillies, Malcolm B.

AU - Bateman, Brian T.

AU - Chan, Adrienne Y.L.

AU - Cheng, Michael C.Y.

AU - Cho, Yongtai

AU - Choi, Eunyoung

AU - Cohen, Jacqueline M.

AU - Donald, Sarah

AU - Furu, Kari

AU - Gissler, Mika

AU - Gomes, Tara

AU - Havard, Alice

AU - Hernandez-Diaz, Sonya

AU - Hsieh, Miyuki H.C.

AU - Huybrechts, Krista F.

AU - Karlsson, Par

AU - Kelty, Erin

AU - Lai, Edward C.C.

AU - Ledlie, Shaleesa

AU - Wang, Tianru

AU - Leinonen, Maarit K.

AU - Parkin, Lianne

AU - Reutfors, Johan

AU - Shin, Jo-Young

AU - Su, Chris T.T.

AU - Varney, Bianca

AU - Wong, Ian C.K.

AU - Man, Kenneth K.C.

AU - Zoega, Helga

N1 - Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PY - 2025/6

Y1 - 2025/6

N2 - Background: Pain is common during pregnancy, yet there are few contemporary studies of opioid use in pregnancy. This study aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania (New South Wales, Australia, and New Zealand), North America (Ontario, Canada, and United States), Northern Europe (Denmark, Finland, Iceland, Norway, Sweden, and United Kingdom), and East Asia (Hong Kong, South Korea, and Taiwan). Methods: A common protocol was applied to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy before birth in 2000 to 2020. The populations captured included those with public and private insurance in the United States, a sample of primary care practices in the United Kingdom, and whole-of-population cohorts in the remainder of the locations. This study examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. Use by sociodemographic and pregnancy characteristics is described. Results: Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1,000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1,000 in the United Kingdom to 191 per 1,000 in the U.S. publicly insured population. The greatest relative decrease in prevalence was observed in Hong Kong (prevalence ratio, 0.2; 95% CI, 0.1 to 0.2 between 2005 and 2020), and the greatest increase was in Iceland (prevalence ratio, 4.4; 95% CI, 3.7 to 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 1,000. conclusions: In this large multinational study, wide global variation in the prevalence of analgesic opioid use in pregnancy was observed, 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 use in pregnancy. This study aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania (New South Wales, Australia, and New Zealand), North America (Ontario, Canada, and United States), Northern Europe (Denmark, Finland, Iceland, Norway, Sweden, and United Kingdom), and East Asia (Hong Kong, South Korea, and Taiwan). Methods: A common protocol was applied to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy before birth in 2000 to 2020. The populations captured included those with public and private insurance in the United States, a sample of primary care practices in the United Kingdom, and whole-of-population cohorts in the remainder of the locations. This study examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. Use by sociodemographic and pregnancy characteristics is described. Results: Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1,000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1,000 in the United Kingdom to 191 per 1,000 in the U.S. publicly insured population. The greatest relative decrease in prevalence was observed in Hong Kong (prevalence ratio, 0.2; 95% CI, 0.1 to 0.2 between 2005 and 2020), and the greatest increase was in Iceland (prevalence ratio, 4.4; 95% CI, 3.7 to 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 1,000. conclusions: In this large multinational study, wide global variation in the prevalence of analgesic opioid use in pregnancy was observed, 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.

KW - Adult

KW - Analgesics, Opioid/therapeutic use

KW - Cohort Studies

KW - Drug Prescriptions/statistics & numerical data

KW - Female

KW - Global Health

KW - Humans

KW - Internationality

KW - Pain/drug therapy

KW - Practice Patterns, Physicians'

KW - Pregnancy

KW - Pregnancy Complications/drug therapy

KW - Retrospective Studies

KW - Young Adult

UR - https://www.scopus.com/pages/publications/85217918008

UR - https://journals.lww.com/anesthesiology/fulltext/2025/06000/global_trends_in_analgesic_opioid_use_in.25.aspx

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 -

Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study

Abstract

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