The five years that have passed since the last IAU Symposium devoted to massive stars have seen a veritable explosion of data on the high redshift universe. The tools developed to study massive stars in nearby galaxies are finding increasing application to the analysis of the spectra of star-forming regions at redshifts as high as z = 7. In this brief review, I consider three topics of relevance to this symposium: the determination of the metallicities of galaxies at high redshifts from consideration of their ultraviolet stellar spectra; constraints on the initial mass function of massive stars in galaxies at z = 2 − 3; and new clues to the nucleosynthesis of carbon and nitrogen in massive stars of low metallicity. The review concludes with a look ahead at some of the questions that may occupy us for the next five years (at least!).