title: Prenatal Triptan Exposure and Internalising and Externalising Behaviour Problems in 3-Year-Old Children: Results from the Norwegian Mother and Child Cohort Study.
abstract: BACKGROUND
  Triptans are commonly prescribed for migraine, a pain condition that is highly prevalent in women of childbearing age. No prior studies have investigated associations between exposure to triptans during fetal life and risk of externalising and internalising behaviours in children.
  
  
  METHODS
  This study was set in the Norwegian Mother and Child Cohort study, a prospective birth cohort. A total of 41,173 live, singleton births without major malformations present at 36-month post-partum follow-up were included in this study; 396 used a triptan during pregnancy, 798 used a triptan prior to pregnancy only, 3291 reported migraine without triptan use, and 36,688 reported no history of migraine or triptan use. Marginal structural models were used to analyse the association between timing of triptan exposure and neurodevelopmental outcome.
  
  
  RESULTS
  Children exposed to triptans during pregnancy had a 1.39-fold increased risk of externalising behaviours compared with those whose mothers used triptans prior to pregnancy only (95% CI 0.97, 1.97), a 1.36-fold increased risk compared with the unmedicated migraine group (95% CI 1.02, 1.81), and a 1.41-fold increased risk compared with the population comparison group (95% CI 1.08, 1.85). The greatest risk was associated with first trimester exposure (RR 1.77, 95% CI 0.98, 3.14). Risk differences were small, ranging from 3-6%.
  
  
  CONCLUSIONS
  This study found an increased risk of clinically relevant externalising behaviours in children with prenatal exposure to triptans, and this risk was highest for first trimester exposure. Absolute risks were small, and the results may be due to confounding by underlying migraine severity.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.|Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA.|Department of Pharmacy, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.|Pharmacoepidemiology and Drug Safety Research Group, Oslo, Norway.
authors.forename: Mollie E
authors.initials: ME
authors.lastname: Wood
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Kate
authors.initials: K
authors.lastname: Lapane
authors.affiliation: Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Frazier
authors.affiliation: Division of Mental Health, National Institute of Public Health, Oslo, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Ystrom
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Mick
authors.affiliation: Department of Pharmacy, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.|Division of Mental Health, National Institute of Public Health, Oslo, Norway.|Pharmacoepidemiology and Drug Safety Research Group, Oslo, Norway.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Nordeng
mesh_terms: D002653:Child Behavior Disorders / Q000139:chemically induced* / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008881:Migraine Disorders / Q000188:drug therapy; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000453:epidemiology; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000453:epidemiology; D011446:Prospective Studies; D058825:Serotonin 5-HT1 Receptor Agonists / Q000009:adverse effects*; D014363:Tryptamines / Q000009:adverse effects*
chemical_list: D058825:Serotonin 5-HT1 Receptor Agonists; D014363:Tryptamines
keywords: neurodevelopment; pregnancy; triptans