Pregnancy Outcome Following Prenatal Exposure to Triptan Medications: A Meta‐Analysis

Marchenko, A. S.; Etwel, Fatma; Olutunfese, Olukayode; Nickel, Cheri; Koren, Gideon; Nulman, Irena

doi:10.1111/head.12500

Cited by 94 publications

(66 citation statements)

References 37 publications

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“…The safety of acute and prophylactic treatment of migraine in pregnancy has previously been assessed . While paracetamol is generally considered safe, NSAID use in the first trimester may increase the risk of miscarriage and birth defects and NSAID use in subsequent trimesters may have adverse effects on neonatal outcomes, including cerebral palsy .…”

Section: Discussionmentioning

confidence: 99%

“…While paracetamol is generally considered safe, NSAID use in the first trimester may increase the risk of miscarriage and birth defects and NSAID use in subsequent trimesters may have adverse effects on neonatal outcomes, including cerebral palsy . A meta‐analysis of 6 studies found no increased risk of miscarriage, preterm delivery, and birth defects in triptan‐exposed migraine patients compared with triptan‐unexposed migraine patients, but an increased risk of miscarriage was found when the triptan‐exposed migraine patients were compared with healthy controls without migraine . While effective as migraine prophylaxis, use of beta‐blockers may increase the risk of some neonatal outcomes .…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine

et al. 2019

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Background Prevalence of migraine is high during the reproductive age. Although migraine often improves during pregnancy, the risk of adverse pregnancy, birth, neonatal, and neurological outcomes in mother and offspring remains poorly understood. Objective To investigate the associations between maternal migraine and risks of adverse pregnancy outcomes in the mother, and birth, neonatal and postnatal outcomes in the offspring. Methods We used Danish population registries to assemble a cohort of pregnancies among women with migraine and an age‐ and conception year‐matched comparison cohort of pregnancies among women without migraine. The study period was 2005‐2012. We computed adjusted prevalence ratios (aPRs) for pregnancy and birth outcomes and adjusted risk ratios (aRRs) for neonatal and postnatal outcomes, adjusting for age, preconception medical history, and preconception reproductive history. Results We identified 22,841 pregnancies among women with migraine and 228,324 matched pregnancies among women without migraine. Migraine was associated with an increased risk of pregnancy‐associated hypertension disorders (aPR: 1.50 [95% confidence interval (CI): 1.39‐1.61]) and miscarriage (aPR: 1.10 [95% CI: 1.05‐1.15]). Migraine was associated with an increased prevalence of low birth weight (aPR: 1.14 [95% CI: 1.06‐1.23]), preterm birth (aPR: 1.21 [95% CI: 1.13‐1.30]) and cesarean delivery (aPR: 1.20 [95% CI: 1.15‐1.25]), but not of small for gestational age offspring (aPR: 0.94 [95% CI: 0.88‐0.99]) and birth defects (aPR: 1.01 [95% CI: 0.93‐1.09]). Offspring prenatally exposed to maternal migraine had elevated risks of several outcomes in the neonatal and postnatal period, including intensive care unit admission (aRR: 1.22 [95% CI: 1.03‐1.45]), hospitalization (aRR: 1.12 [95% CI: 1.06‐1.18]), dispensed prescriptions (aRR: 1.34 [95% CI: 1.24‐1.45]), respiratory distress syndrome (aRR: 1.20 [95% CI: 1.02‐1.42]), and febrile seizures (aRR: 1.27 [95% CI: 1.03‐1.57), but not of death (aRR: 0.67 [95% CI: 0.43‐1.04]) and cerebral palsy (aRR: 1.00 [95% CI: 0.51‐1.94]). Conclusions Women with migraine and their offspring have greater risks of several adverse pregnancy outcomes than women without migraine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine

et al. 2019

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“…There are virtually no treatments for headache disorders that lack any potential for teratogenicity. Common acute treatments such as NSAIDs are generally avoided during most of pregnancy, ergotamine compounds are contraindicated, and though the emerging evidence suggests safety for occasional use of triptans, regular and repeated use in pregnant women is of uncertain safety. More established preventative therapies including beta‐blockers, tricyclic antidepressants, antiepileptic drugs, and onabotulinumtoxinA all may have the potential for crossing the placenta and teratogenicity of varying degrees .…”

Section: Neuromodulation In Special Populationsmentioning

confidence: 99%

Neuromodulation for the Acute and Preventive Therapy of Migraine and Cluster Headache

2019

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Headache disorders are among the most common and disabling medical conditions worldwide. Pharmacologic acute and preventive treatments are often insufficient and poorly tolerated, and the majority of patients are unable to adhere to their migraine treatments due to these issues. With improvements in our understanding of migraine and cluster headache pathophysiology, neuromodulation devices have been developed as safe and effective acute and preventive treatment options. In this review, we focus on neuromodulation devices that have been studied for migraine and cluster headache, with special attention to those that have gained food and drug administration (FDA) clearance. We will also explore how these devices can be used in patients who might have limited pharmacologic options, including the elderly, children, and pregnant women.

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“…12,13 Sumatriptan exposure has not been associated with fetal malformations or adverse outcomes and, if other treatments have failed, it may be used to treat acute migraine attacks. If attacks are frequent, then prophylactic medication should be considered.…”

mentioning

confidence: 99%

Medical problems in pregnancy

Narayan

Nelson‐Piercy

2017

Clinical Medicine

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The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy. This includes prepregnancy measures such as counselling and optimisation of medical therapy, as well as multidisciplinary management throughout pregnancy and the postpartum period. Prompt recognition and treatment of acute and chronic illness is of clear benefit, and most drugs and many radiological investigations may be used in pregnancy.

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Pregnancy Outcome Following Prenatal Exposure to Triptan Medications: A Meta‐Analysis

Abstract: The use of triptans during pregnancy does not appear to increase the rates for MCMs or prematurity. The increased rates of spontaneous abortions in the triptan-exposed group and the increased rates of MCM in the migraine no-triptan group require further research.

Cited by 94 publications

References 37 publications

Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine

Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine

Neuromodulation for the Acute and Preventive Therapy of Migraine and Cluster Headache

Medical problems in pregnancy

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