Pregnancy Outcome Following Prenatal Exposure to Triptan Medications: A Meta-analysis

Alexander Marchenko, MD; Fatma Etwel, MSc; Olukayode Olutunfese, MD; Cheri Nickel, BSW; Gideon Koren, MD; Irena Nulman, MD

Disclosures

Headache. 2015;55(4):490-501. 

In This Article

Results

One case–control study and 5 cohort studies met the inclusion criteria (Table 1). The included studies provided information on duration of gestation, major congenital malformations, and spontaneous abortions of infants following prenatal triptan exposure. The 6 studies included 4208 infants of women who used sumatriptan or other triptan medications, and 1,466,994 children of women who did not use triptans during pregnancy Table 2.

Meta-analysis of the Rates of Major Congenital Malformations in Triptan-exposed vs Migraine No-triptan Women (Disease Control)

Three studies were used, with a total of 4069 exposed and 1732 unexposed women with migraines. The meta-analysis yielded a summary OR and 95% CI of 0.84 (0.61–1.16). The studies were homogeneous (test for heterogeneity, P = .789, I2 = 0%) (Fig. 2).

Figure 2.

Forest plot for random-effects meta-analysis of triptan-exposed vs migraine control women for rates of major congenital malformations.

Meta-analysis of the Rates of Major Congenital Malformations in Triptan-exposed vs Healthy Control Women

In this meta-analysis, we included 4 studies assessing 4208 infants of women who used triptan medications for migraine during the first trimester of pregnancy and 1,465,082 infants of healthy women. The OR and 95% CI were 1.18 (0.97–1.44) for the incidence of abnormalities following exposure to triptans; the results were not significant. The studies were homogeneous (test for heterogeneity, P = .305, I2 = 17.289%) (Fig. 3).

Figure 3.

Forest plot for random-effects meta-analysis of triptan-exposed vs healthy control women for rates of major congenital malformations.

Meta-analysis of the Rates of Major Congenital Malformations in Migraine No-triptans vs Healthy Control Women

Three studies examined the rates of fetal major congenital malformations for pregnant women with migraines who were not exposed to triptans vs healthy pregnant women. With a total of 1735 women with migraines and 1,408,557 healthy controls, the summary OR and 95% CI was 1.41 (1.11–1.80) The results were significant for increased rates of major congenital malformations among untreated women suffering from migraines. The studies were homogeneous (test for heterogeneity, P = .422, I2 = 0%) (Fig. 4).

Figure 4.

Forest plot for random-effects meta-analysis of migraine control vs healthy control women for rates of major congenital malformations.

Meta-analysis of the Rates of Spontaneous Abortions in Triptan-exposed vs Migraine No-triptans Women

Two studies that examined the rates of spontaneous abortion for pregnant women exposed to triptans were included in the meta-analysis (total of 172 exposed and 188 unexposed controls). The OR and 95% CI for incidence of spontaneous abortion after exposure to triptan medications were 1.27 (0.58–2.79). The studies were homogeneous (test for heterogeneity, P = .266, I2 = 19.59%) (Fig. 5).

Figure 5.

Forest plot for random-effects meta-analysis of triptan-exposed vs migraine control women for rates of spontaneous abortion.

Meta-analysis of the Rates of Spontaneous Abortions in Triptan-exposed vs Healthy Control Women

Two studies that examined the rates of spontaneous abortion for pregnant women exposed to triptans were included in the meta-analysis (total of 178 exposed and 50,865 healthy controls). The OR and 95% CI for incidence of spontaneous abortion after exposure to triptan medications were 3.54 (2.24–5.59). The studies were homogeneous (test for heterogeneity, P = .757, I2 = 0%) (Fig. 6).

Figure 6.

Forest plot for random-effects meta-analysis of triptan-exposed vs healthy control women for rates of spontaneous abortion.

Meta-analysis of the Rates of Prematurity in Triptan-exposed vs Migraine No-triptans Women

Three studies estimated the rates of prematurity between 1581 infants of pregnant women exposed to triptans and 1231 infants of migraineur women who were not exposed to triptan medications during pregnancy. The OR and 95% CI was 0.90 (0.35–2.30). The results were heterogeneous (test for heterogeneity, P = .023, I2 = 73.62%) (Fig. 7).

Figure 7.

Forest plot for random-effects meta-analysis of triptan-exposed vs migraine control women for rates of prematurity of infants.

Meta-analysis of the Rates of Prematurity in Triptan-exposed vs Healthy Control Women

Four studies examined the rates of prematurity for pregnant women exposed to triptans vs healthy pregnant women. With the total of 1720 infants of exposed and 251,085 healthy controls, the summary adjusted OR and 95% CI was 1.16 (0.67–1.99). The results were heterogeneous (test for heterogeneity, P = .067, I2 = 58.174%) (Fig. 8).

Figure 8.

Forest plot for random-effects meta-analysis of triptan-exposed vs healthy control women for rates of prematurity of infants.

Meta-analysis of the Rates of Prematurity in Migraine No-triptans vs Healthy Control Women

Three studies examined the rates of prematurity for pregnant women with migraines who did not use triptan medications vs healthy pregnant women. With a total of 1274 women with migraines and 194,560 healthy controls, the summary adjusted OR and 95% CI was 1.44 (0.66–3.16). The results were heterogeneous (test for heterogeneity, P = .054, I2 = 65.63%) (Fig. 9).

Figure 9.

Forest plot for random-effects meta-analysis of migraine control vs healthy control women for rates of prematurity of infants.

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