Use of 5-HT1 agonists in pregnancy.
OBJECTIVE
To report and evaluate available data on the use of serotonin 5-HT(1) agonists (triptans) during pregnancy.


METHODS
A PubMed search, limited to English-language articles on human subjects, was conducted (1990-December 2007) using the search terms pregnancy, migraine, and the individual triptan drug names. In addition, the manufacturers of all 7 available triptans were contacted regarding the existence of a pregnancy registry for their drug(s) and the availability of registry reports.


METHODS
All retrospective and prospective studies reporting on pregnancy outcomes after the use of a triptan were included and critically evaluated. Data from all available manufacturer-sponsored pregnancy registries were also included.


RESULTS
Safe and effective treatment of migraine during pregnancy is imperative. Data involving sumatriptan and, to a lesser extent, naratriptan and rizatriptan, exist primarily regarding exposure in the first trimester. These data show no significant differences in congenital malformations or poor pregnancy outcomes when compared with expected rates in the general population or with the observed rates in control subjects. There is very little information regarding exposure in middle and late pregnancy.


CONCLUSIONS
Sumatriptan appears to be a safe treatment alternative for pregnant women who experience new-onset or worsened migraines in the first trimester. Further observation is needed prior to recommending its use in later trimesters. Based upon available data, the other agents in this class cannot be recommended for use during pregnancy at this time.
Evans
Emily W
EW
Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA. eevans@ulm.edu
Lorber
Kristin C
KC
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology / Q000209:etiology; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy* / Q000503:physiopathology; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D012042:Registries; D012189:Retrospective Studies; D017366:Serotonin Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D014363:Tryptamines / Q000009:adverse effects / Q000627:therapeutic use*; D016387:Women's Health
D017366:Serotonin Receptor Agonists; D014363:Tryptamines