title: Dihydroergotamine (DHE) use during gestation and the risk of adverse pregnancy outcomes.
abstract: BACKGROUND
  Dihydroergotamine (DHE) is perceived to be associated with a higher risk of adverse pregnancy events, but it has significantly less vasoconstrictive and uterotonic effects compared with ergotamine, and has demonstrated no teratogenic effect in animals. The objectives of this study were to quantify the risk of major congenital malformations (MCMs), prematurity, low birth weight (LBW), and spontaneous abortions (SAs) associated with gestational use of DHE, triptans, and nonsteroidal anti-inflammatory drugs (NSAIDs).
  
  
  METHODS
  Four independent case-control analyses were conducted within the Quebec Pregnancy Registry: (1) MCM; (2) prematurity (<37 weeks of gestation); (3) LBW (birth weight <2500 g); (4) clinically detected SA. Exposure was defined dichotomously as use of DHE, triptan, and NSAIDs during pregnancy.
  
  
  RESULTS
  Overall, 59,707 pregnant women met the eligibility criteria and were considered (53 [0.08%] used DHE, 139 [0.23%] triptans, and 2990 [5.01%] NSAIDs). Adjusting for potential confounders, gestational use of DHE was not significantly associated with the risk of MCM (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.22-4.28), LBW (OR: 1.41; 95%CI: 0.25-7.80), or SA (OR: 1.97; 95% CI: 0.21-18.57). DHE use was, however, increasing the risk of prematurity (OR: 4.18; 95% CI: 1.34-12.99). In users of triptans, the OR for MCM was 1.49 (95% CI: 0.89-2.52), prematurity 0.76 (95% CI: 0.34-1.66), LBW 0.83 (95% CI: 0.31-2.25), and SA 2.65 (95% CI: 1.57-4.48). In users of NSAIDs, the OR for MCM was 1.20 (95% CI: 1.06-1.36), prematurity 1.10 (95% CI: 0.95-1.26), LBW 1.29 (95% CI: 1.08-1.54), and SA 2.97 (95% CI: 2.63-3.36).
  
  
  CONCLUSIONS
  This study showed that other than for prematurity, DHE use during pregnancy was similar to that of triptan use and was smaller than the risk associated with NSAID use.
authors.affiliation: Faculty of Pharmacy, University of Montreal, Sainte-Justine Hospital, Research Center, 3175 chemin de la Côte-Ste-Catherine, Montreal, QC, Canada. anick.berard@umontreal.ca
authors.forename: Anick
authors.initials: A
authors.lastname: Bérard
authors.forename: Shashidhar
authors.initials: S
authors.lastname: Kori
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology*; D004087:Dihydroergotamine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D008881:Migraine Disorders / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011792:Quebec; D012042:Registries; D012307:Risk Factors; D014363:Tryptamines / Q000009:adverse effects / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D014363:Tryptamines; D014662:Vasoconstrictor Agents; D004087:Dihydroergotamine