Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
JAMA Netw Open. 2022 Jun 1;5(6):e2215333. doi: 10.1001/jamanetworkopen.2022.15333.
Triptans are commonly used in the treatment of migraine. Prenatal exposure to triptans may be associated with adverse fetal neurodevelopment; however, there is limited information about the long-term safety of triptan use during pregnancy.
To examine the association between maternal use of triptans during pregnancy and diagnosis and symptoms of attention-deficit/hyperactivity disorder (ADHD) among offspring.
DESIGN, SETTING, AND PARTICIPANTS: This study used data from the Norwegian Mother, Father and Child Cohort Study (recruitment 1999-2008), linked to national health registries. Live-born singleton children born to women with migraine before or during pregnancy were included. Two analytic samples were defined: one to assess ADHD diagnosis and one to assess ADHD symptoms. Data were analyzed from May 1 to November 30, 2021.
Maternal self-report of triptan use during pregnancy. Exposed children were compared with 2 groups of unexposed children whose mothers reported migraine (1) during pregnancy and (2) before pregnancy only.
An ADHD diagnosis was defined as diagnosis of hyperkinetic disorder or receipt of dispensed ADHD medication. Symptoms of ADHD at 5 years were measured by the Conners' Parent Rating Scale, where a higher score indicates more symptoms of ADHD. Cox proportional hazards regression models and generalized linear models with inverse probability weights were used to estimate weighted hazard ratios (HRs) and standardized mean differences, respectively, with 95% CIs.
The ADHD diagnosis sample comprised 10 167 children (mean [SD] maternal age, 30.2 [4.6] years; 5231 boys [51.5%]), and the ADHD symptoms sample comprised 4367 children (mean [SD] maternal age, 30.6 [4.4] years; 2191 boys [50.2%]). Children were followed up for a mean (SD) of 10.6 (2.2) years. Children with prenatal triptan exposure had no increased risk of ADHD diagnosis compared with unexposed children whose mothers had migraine during pregnancy (weighted HR, 1.16; 95% CI, 0.78-1.74) and compared with unexposed children whose mothers had migraine only before pregnancy (weighted HR, 1.28; 95% CI, 0.84-1.94). There were no differences in ADHD symptom scores between exposed and unexposed children.
The findings of this study suggest that there is no increased risk of ADHD among offspring associated with prenatal exposure to triptans.
曲坦类药物常用于偏头痛的治疗。产前暴露于曲坦类药物可能与胎儿神经发育不良有关；然而，关于怀孕期间使用曲坦类药物的长期安全性信息有限。
研究母亲在怀孕期间使用曲坦类药物与后代注意缺陷多动障碍（ADHD）的诊断和症状之间的关系。
设计、地点和参与者：本研究使用了挪威母婴儿童队列研究（招募时间为 1999-2008 年）的数据，并与国家健康登记处进行了链接。纳入了在怀孕前或怀孕期间患有偏头痛的女性所生的单胎活产儿。定义了两个分析样本：一个用于评估 ADHD 的诊断，另一个用于评估 ADHD 的症状。数据分析于 2021 年 5 月 1 日至 11 月 30 日进行。
母亲报告怀孕期间使用曲坦类药物。暴露组的儿童与以下两组未暴露组的儿童进行比较：（1）母亲在怀孕期间患有偏头痛，（2）母亲仅在怀孕前患有偏头痛。
ADHD 的诊断定义为多动障碍的诊断或接受 ADHD 药物的处方。5 岁时的 ADHD 症状通过 Conners' 父母评定量表进行测量，得分越高表示 ADHD 症状越多。使用逆概率加权的 Cox 比例风险回归模型和广义线性模型分别估计加权风险比（HR）和标准化平均差异，置信区间为 95%。
ADHD 诊断样本包括 10167 名儿童（母亲平均年龄[标准差]，30.2[4.6]岁；5231 名男孩[51.5%]），ADHD 症状样本包括 4367 名儿童（母亲平均年龄[标准差]，30.6[4.4]岁；2191 名男孩[50.2%]）。儿童的平均（标准差）随访时间为 10.6（2.2）年。与在怀孕期间患有偏头痛的未暴露组儿童（加权 HR，1.16；95%CI，0.78-1.74）和与仅在怀孕前患有偏头痛的未暴露组儿童（加权 HR，1.28；95%CI，0.84-1.94）相比，产前暴露于曲坦类药物的儿童患 ADHD 的风险没有增加。暴露组和未暴露组儿童的 ADHD 症状评分无差异。
本研究结果表明，产前暴露于曲坦类药物与后代 ADHD 无关。
