Tracking Triptan Safety During Pregnancy
Prenatal exposure to triptans, alone or with other migraine medications, was not associated with a significantly increased risk for neurodevelopmental disorders (NDDs) in children born to mothers with a history of migraine in a new study.
METHODOLOGY:
Researchers conducted a registry-based cohort study in Norway, using data from multiple national health registries between 2008 and 2023.
The study included more than 26,000 children born to mothers with migraine, with the children followed up to 14 years of age. Among the mothers, 81% used triptans and 19% did not.
Prenatal exposure to triptans and other antimigraine medications was determined by prescription fills from 12 months before pregnancy until delivery. Exposure was grouped as low use (42%), short-term low use (31%), moderate use (21%), and high use (6%).
The primary outcome was diagnosis in the children of a composite of any NDD, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and language or speech disorders.
TAKEAWAY:
Among the 4% of children who developed an NDD during the study, ADHD was the most common condition.
Children with any prenatal exposure to triptans had a slight but not substantial increased risk for NDD compared with those with no exposure (low use weighted hazard ratio [wHR], 1.08; short-term low use wHR, 1.05; moderate use wHR, 1.09; high use wHR, 1.16). These risks decreased to null when the comparator was in low use (wHR range, 0.94-1.01).
A slightly increased risk for ASD was observed in children with moderate and high exposure to triptans (wHRs, 1.24 and 1.30, respectively), but the weighted risk differences were less than 1%.
The probability of exposure to other antimigraine medications was less than 10%. Prenatal exposure to co-medications was not significantly associated with the composite NDD outcome.
IN PRACTICE:
'These results are encouraging for people with migraine, who may be taking these drugs before they even know that they are pregnant, and this is helpful information for their physicians, who can make more informed decisions about treating people with debilitating migraine attacks,' study investigator Hedvig Nordeng, PhD, University of Oslo, Oslo, Norway, said in a press release.
SOURCE:
The study was led by Margherita Camanni, University of Milano-Bicocca, Milan, Italy. It was published online on May 21 in Neurology .
LIMITATIONS:
The study relied on filled prescriptions instead of verified medication intake, potentially leading to exposure misclassification. The researchers could not assess the risk for specific NDDs in children after prenatal exposure to combined migraine treatments and individual triptans because of small sample sizes. Additionally, the study could not verify whether medication discontinuation at the last menstrual period was due to lower migraine severity. The possibility of live birth bias and confounding by other treatment indications could not be eliminated.
DISCLOSURES:
Camanni reported receiving a visiting scholarship from the Norwegian Research Council for this study. The other investigators reported no relevant conflicts of interest.
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