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
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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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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. 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Use by sociodemographic and pregnancy characteristics is described.</p><p><strong>Results: </strong>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. 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引用次数: 0
摘要
背景：疼痛是常见的在怀孕期间，但很少有阿片类药物在怀孕期间的使用当代研究。我们的目的是描述四个地区的处方镇痛阿片类药物在怀孕期间的使用情况：大洋洲[新南威尔士州（澳大利亚），新西兰]，北美[安大略省（加拿大），美国（美国）]，北欧[丹麦，芬兰，冰岛，挪威，瑞典，英国]和东亚（香港，韩国，台湾）。方法：我们采用一种基于人群的通用方案来测量2000-2020年孕产期镇痛阿片类药物的配药或处方。被捕获的人群包括美国拥有公共和私人保险的人群，英国初级保健实践的样本，以及其他国家的全体人群。我们检查了使用的流行程度，定义为至少一种配药或处方，并估计了随时间的趋势。我们根据社会人口学和妊娠特征描述了使用情况。结果：在总共20,306,228例怀孕中，1,115,853例（每1000人中有55例）至少有一种镇痛阿片类药物配药或处方，从英国的每1000人中有4例到美国的每1000人中有191例。我们观察到香港的患病率相对下降幅度最大(患病率为0.2；2005年至2020年，95%可信区间为0.1-0.2)，冰岛的增幅最大(患病率4.4；2004年至2017年，95% CI 3.7-5.2)。可待因和曲马多是大多数人群中最常见的三种阿片类药物。在一项将阿片类药物使用定义为两次或两次以上阿片类药物配药或处方事件的敏感性分析中，阿片类药物使用在人群中的流行率为17 / 1000。结论：在这项大型跨国研究中，我们观察到全球范围内阿片类镇痛药物在妊娠期使用的普遍差异，但社会人口统计学和妊娠特征的使用模式相对一致。在大多数（但不是全部）国家，镇痛类阿片的使用随着时间的推移保持稳定或呈下降趋势。
Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study.
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.
期刊介绍：
With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.
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