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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., (Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists.)

The aim of this study was to examine variations in use of antidepressants among children and adolescents in the three Scandinavian countries (Sweden, Norway, and Denmark). We identified new users of antidepressants (5-17 years) during 2007-2018 and described the annual incidence rate, treatment duration, concomitant psychotropic drug use, and the clinical setting of the prescribing physician (in Sweden and Denmark). Incident use of antidepressants increased by a factor 1.9 in Sweden, 1.3 in Norway and decreased by a factor 0.6 in Denmark during the study period. In Sweden, 58% of antidepressant users were covered by a prescription 12 months after initiation compared to 40% in Norway and 49% in Denmark. Also, 34% of Swedish antidepressant users were in continuous treatment after 12 months compared to 26% in Norway and 31% in Denmark. Concomitant use of other psychotropics was more common in Sweden (57%) than in Norway (37%) and Denmark (27%). During 2007-2018, clinicians from psychiatry settings initiated 75% of antidepressant treatments in Sweden, while this was the case for 50% of prescriptions in Denmark, although the proportion increased over time. The number of new antidepressant users is high and still rising in Sweden compared to Norway and Denmark. Swedish antidepressant users are more likely to use other psychotropics and to be covered by an antidepressant prescription after one year. Most antidepressants in Sweden are prescribed by physicians within psychiatric settings suggesting that they are based on specialized psychiatric evaluation., Competing Interests: Declarations. Conflict of interest: LR, MB, KF, SVSK, RS, PD and RW declare no conflict of interest. JR is employed at the Centre for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, and contract research organizations) for performance of drug safety and drug utilization studies, with no relation to the work reported in this paper. Ethical approval: The study was approved by the Danish Data Protection Agency (10.080). According to Danish legislation, approval from an ethics Committee is not required for registry-based studies. The Regional Committee for Medical Research Ethics (2010/131) and the Norwegian Data Protection Authority (10/00447-5) approved the register linkage. The use of Swedish data for this study was approved by the Swedish Ethical Review Authority (no. 2017/1236–31/2)., (© 2024. The Author(s).)