Prenatal triptan use for migraine and child neurodevelopment: A systematic review

Objective: Triptans are a commonly used medication for acute migraine relief and can cross the placental barrier in pregnancy. We conducted a systematic review to summarize and evaluate published literature examining the association between prenatal triptan use for migraine and child neurodevelopmental outcomes. Methods: Search terms for “pregnancy” and “triptans” were used to search Medline (Ovid), Embase (Ovid), and CINAHL (EBSCO) for relevant studies published from database inception to August 2023. Original research studies examining the relationship between triptan use for migraine during pregnancy and any child neurodevelopmental outcomes were included. An adapted version of the Systematic Assessment of Quality in Observational Research (SAQOR) tool was used for quality assessment. We conducted a narrative synthesis of eligible studies. Results: Our search strategy retrieved 1407 articles, of which five met inclusion criteria for the narrative synthesis. All studies used data from the Norwegian Mother and Child Cohort Study (MoBa), used parental self-report to measure triptan use during pregnancy, and were of moderate quality. Outcomes examined varied across studies and included externalising and internalising behaviours, communication, psychomotor function, temperament, and attention-deficit/hyperactivity disorder. Two studies reported an association between prenatal triptan use and externalising behaviours in children up to three years old, but no associations with other neurodevelopmental outcomes or in older children were found. All studies accounted for confounding by indication for migraine, but residual confounding by migraine severity was possible. Conclusion: Prenatal triptan exposure may be associated with an increased risk of externalising behaviours in children aged 1.5-3 years. Future studies outside the MoBa cohort are needed to assess the internal and external validity of these findings. Consideration of individual triptans as distinct exposures and the use of measures of in utero triptan exposure that are less susceptible to recall bias than retrospective self-report are important directions for future research.