Aotearoa New Zealand has been identified as having the third-highest prevalence of prescribed opioid use during pregnancy, according to a multi-national study that included 13 high-income countries. The study, led by the University of New South Wales and published in the journal Anesthesiology, found that nearly 8% of pregnancies in New Zealand were exposed to opioids, a stark contrast to the global average and notably higher than the 4% in Canada and 0.4% in the UK. Only the United States and Iceland reported higher rates. The research, conducted by Dr. Sarah Donald from the University of Otago’s Department of Preventive and Social Medicine and co-authored by Professor Lianne Parkin, analyzed anonymized data from over 20 million pregnancies between the years 2000 and 2020. The study excluded opioid use during childbirth, focusing instead on prenatal exposure. Despite finding stable or downward trends in most countries, the rates in New Zealand remained consistently high. Codeine and tramadol were the most commonly prescribed opioids during this period. One of the key findings of the study was that opioid use was more prevalent in later stages of pregnancy and among individuals with lower income and higher body mass index (BMI). Dr. Donald noted that the general trend of increased prescription medication use during pregnancy over the past two decades could be attributed to several factors, including the aging population of pregnant individuals, a higher prevalence of medical conditions requiring treatment, and greater awareness of historical undertreatment of pregnant people. However, the specific drivers behind the increased use of opioids in New Zealand remain unclear. Dr. Donald emphasized that approximately 80% of those using opioids during pregnancy received just one prescription, which suggests that the majority of cases involve short-term use. This finding is somewhat reassuring, given the potential risks associated with prolonged opioid exposure. Opioids are known to cross the placenta, potentially exposing the fetus to adverse effects. Professor Parkin highlighted several concerning outcomes linked to opioid use during pregnancy, such as an increased risk of congenital malformations, preterm birth, low birth weight, breathing problems, withdrawal symptoms in the newborn, and long-term neurodevelopmental conditions. These risks underscore the importance of carefully weighing the benefits against the potential harm when prescribing opioids to pregnant individuals. The study’s findings have prompted calls for a review of New Zealand’s current clinical guidelines on opioid use during pregnancy. Dr. Donald and Professor Parkin argue that while pain management is crucial, the guidelines should be updated to reflect the latest research and minimize the risks to both mother and child. They suggest that further research is needed to understand the underlying reasons for the high rates of opioid prescription in New Zealand and to develop targeted interventions to address these issues. Additionally, the researchers recommend enhanced education for healthcare providers to ensure they are aware of the latest evidence and can make informed decisions about pain management in pregnant women. This includes exploring alternative non-opioid pain relief options that are safer for both the mother and the fetus. Industry insiders and experts in maternal health have expressed concern over the implications of the study. They acknowledge the necessity of pain management during pregnancy but stress the need for a balanced approach that prioritizes fetal safety. The American College of Obstetricians and Gynecologists (ACOG) recommends non-pharmacologic treatments as first-line options and emphasizes the importance of minimizing opioid use whenever possible. The University of Otago, established in 1869 and located in Dunedin, is one of New Zealand’s leading research institutions. The Department of Preventive and Social Medicine, where both Dr. Donald and Professor Parkin conduct their research, is dedicated to improving public health through evidence-based interventions and policy recommendations. The study’s findings highlight the university’s commitment to addressing pressing health issues and contributing to the global body of knowledge in maternal health.