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

METHODS:

• 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

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

Pregnancy outcome after anti-migraine triptan use: A prospective observational cohort study.

Related ObG Topics:

Does Acupuncture Decrease Incidence of Migraines?

CDC Guidance: Contraception in Women with Medical Conditions