#Grand Rounds

What are the Consequences of Taking Triptan for Migraine During Pregnancy?

BACKGROUND AND PURPOSE:

50% of pregnancies are unplanned in the US and migraines are common
- As a result, early exposure to triptans (serotonin receptor agonists) during pregnancy can be expected
Due to lack of data, triptans are used less frequently than acetaminophen or NSAIDS during pregnancy
Spielmann et al. (Cephalalgia, 2017) sought to determine the impact of triptan exposure on pregnancy outcome, especially major birth defects and miscarriage

Prospective observational cohort study
Cohorts
- Women with migraine disorder exposed to triptans (exposed cohort=432 women)
- Pregnant women without migraine disorder (non-migraine comparison cohort=1,733 women)
- Pregnant women with migraine disorder but not taking triptans (migraine comparison cohort=475 women)
Primary outcomes were major birth defects and spontaneous abortion
Secondary outcomes were preterm delivery, birth weight, pregnancy complications and the rate of electively terminated pregnancies
Using a baseline risk of 3% for major birth defects, the power of this study would allow for a detection of a 2.0-fold risk increase

75% of exposed cohort took triptans in the first trimester
50.3% took triptans 1–5 days during pregnancy and only 2.3% had a total exposure of >50 days
Sumatriptan was the most frequently used triptan
After adjustments, there was no difference in miscarriage or elective terminations between the exposed cohort and other cohorts
The triptan-exposed pregnancies did not have higher rates of birth defects and this result was not altered based on trimester of exposure
Rates of preterm delivery or preeclampsia did not differ between the 3 cohorts

Triptans were not found to be teratogenic
This study did not find a significant teratogenic effect of triptans or migraine
Sumatriptan, the most studied triptan, appears an acceptable treatment for pregnant women
A detailed fetal ultrasound should be offered in cases of first trimester exposure to less well-studied triptans such as eletriptan or frovatriptan

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