Objective: Triptans are a class of drugs commonly used as an abortive medication for migraine. They can cross the placental barrier in pregnancy and bind to 5-HT receptors in the fetal brain, possibly affecting brain development. The objective of this systematic review was to summarize and evaluate published literature examining the association between prenatal triptan use for migraine and child neurodevelopment. Methods: Search terms for “pregnancy” and “triptans” were used to search MEDLINE, Embase, and CINAHL for relevant studies published from database inception to August 2023. Original research studies published in English examining the relationship between triptan use for maternal migraine during pregnancy and child neurodevelopment were included. An adapted version of the Systematic Assessment of Quality in Observational Research (SAQOR) protocol was used for the quality assessment of included studies. We also performed a narrative synthesis of eligible studies by describing their methods and main findings. Results: Our search strategy retrieved 1093 articles, of which 5 met the inclusion criteria. All 5 studies used data from the Norwegian Mother and Child Cohort Study (MoBa). Studies selected for review all used parental self-report to measure triptan use and were all rated as moderate quality (n = 5, 100%). Outcome variables varied across studies and included externalizing and internalizing behaviour problems, communication, psychomotor function, temperament, and Attention-Deficit/Hyperactivity Disorder (ADHD). Two studies reported an association between prenatal triptan use and externalizing behaviours in children up to 3 years old, but no associations with other neurodevelopmental outcomes or in older children were reported in the literature. All studies accounted for confounding by indication for migraine, but residual confounding by migraine severity was possible. Discussion: Prenatal triptan exposure may be associated with an increased risk of externalizing behaviours in children aged 1.5-3 years old. Future studies outside of the MoBa cohort are required to test the external validity of findings reported in the current literature. Additionally, future studies can expand the state of knowledge by considering different triptans as separate exposures and by utilizing more robust measures of triptan use in pregnancy that are less subject to recall bias than participant self-report.
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