Prenatal triptan exposure does not increase ADHD risk in offspring

Children born to mothers who used triptans for their migraines during pregnancy did not have a greater risk for ADHD symptoms or diagnosis at 5 years of age, according to a Norwegian registry-based study.

The findings, which were published in JAMA Network Open, were “reassuring for pregnant women in need of triptans and their health care providers,” Gerd Marie Harris, MScPharm, a doctoral research fellow at the University of Oslo in Norway, told Healio.

“There is limited knowledge about potential long-term consequences for the child after maternal triptan use in pregnancy, and associations with child ADHD has not been investigated previously to the best of our knowledge,” Harris said. “Triptans are the most commonly used acute medications for migraine, which affects up to 25% of women of fertile age. Information about safety of triptans during pregnancy is thus needed.”

Identifying cohorts

Using data from the Norwegian Mother, Father and Child Cohort Study, Harris and colleagues identified 10,167 singleton children born to women who had migraines before or during pregnancy, whom they included in their ADHD diagnosis sample.

Within this sample, 4,367 children were eligible for the ADHD symptoms sample who did not necessarily have an ADHD diagnosis. These children completed the 5-year questionnaire including 12 items from the Conners’ Parent Rating Scale-Revised, Short Form (CPRS-R[S]) and had at least eight of the 12 items.

Based on maternal self-reports, 832 children in the diagnosis sample and 401 children in the symptoms sample were exposed to triptans prenatally.

Risk for ADHD diagnosis, symptoms

Children who were exposed to triptans prenatally did not have an increased risk for ADHD diagnosis compared with those who were unexposed and whose mothers had migraines during pregnancy (weighted HR = 1.16; 95% CI, 0.78-1.74). They also did not have an increased diagnosis risk compared with children who were unexposed and whose mothers had migraines before pregnancy only (weighted HR = 1.28; 95% CI, 0.84-1.94).

In the ADHD symptom group, mean CPRS-R[S] scores were not significantly different between children with triptan exposure and children with no triptan exposure whose mothers had migraines during pregnancy (weighted mean difference, –0.11; 95% CI, –0.25 to 0.04), or between triptan-exposed children and triptan-unexposed children whose mothers had migraines before pregnancy only (weighted mean difference, –0.09; 95% CI, –0.24 to 0.07).

“The findings are in line with results from our previous work, finding no increased risk of externalizing behavior problems in 5-year-old children associated with maternal triptan use in pregnancy,” Harris said. “... Another study by Mollie E. Wood, PhD, MPH, and colleagues found increased risk of externalizing behavior problems in 3-year-old children in the same cohort, but these problems do not seem to be persistent.”

As for future research, Harris emphasized the importance of investigating the impact of prenatal triptan exposure on the development of autism spectrum disorder and depression, “since these disorders are linked to serotonin, for which triptans act as agonists.”

References:

• Harris GM, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.15333.
• Wood ME, et al. Pharmacoepidemiol Drug Saf. 2016;doi:10.1002/pds.3902.