Use of 5-HT1 agonists in pregnancy

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

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.

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.

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.

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.