13 Oct Anti-CGRP Migraine Drugs in Pregnancy And Risk of Spontaneous Abortion
MedicalResearch.com Interview with:
Professor Anick Bérard PhD FCAHS FISPE
Canada Research Chair Tier 1 on Medications and Pregnancy
Faculty of Medicine, Université Paris Cité, France
Faculty of Pharmacy, University of Montreal
Adjunct Professor, Faculty of Pharmacy, Université Claude Bernard Lyon 1, France
Principal Investigator: Canadian Mother-Child Initiative on Drug Safety in Pregnancy (CAMCCO – Research, Training, Knowledge-Dissemination); CONCEPTION study – COVID-19 and Pregnancy; AMerican PREGNANcy-Mother-Child CohorT (AM-PREGNANT)
Director, Research Unit on Medications and Pregnancy, Research Center – CHU Sainte-Justine
Editor in Chief, Frontiers in Pharmacology – Pharmacoepidemiology
Medication and Pregnancy Notice: Migraine preventive medications, including anti-CGRP therapies and propranolol, should only be prescribed and monitored by your healthcare provider. If you are pregnant, planning a pregnancy, or think you may be pregnant, do not stop, start, or change any medication on your own. Talk with your healthcare provider about the risks and benefits for your individual situation.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response:
- Migraine is very prevalent in pregnancy – 20%.
- It usually improves in the 2nd/3rd trimester – especially for migraine without aura.
- Anti-CGRPs are effective therapies for the prevention of migraine but their safety in pregnancy is unknown. Guidelines do not recommend use during pregnancy except in very few cases. Women with chronic migraine are usually switched to safer alternatives 5-6 months before pregnancy (because of the 30-day half-life – 5 times the half-life). But inadvertent exposures occur.
- Our study is the first large scale study looking at the safety of anti-CGRP during pregnancy for the prevention of chronic migraine. Using data from US pregnant women with chronic migraine, anti-CGRP use increased the risk of spontaneous abortion by 42% (baseline risk of clinically detected spontaneous abortions is 6-8%; the absolute risk on anti-CGRP becomes 8-11%); but propranolol use did not. Our findings are in line with the current guidelines on migraine preventive therapies which recommend discontinuation of anti-CGRP at least 5 months before conception and switch to established migraine preventive therapies such as propranolol.
Shani Vaknine[/caption]
Shani Vaknine, Ph.D. candidate
Brain and Behavioral Sciences
The Hebrew University
MedicalResearch.com: What is the background for this study?
Response: We’ve long known that maternal stress during pregnancy can affect her baby’s development, but the molecular mechanisms behind this remained unclear. In our study, we explored how psychosocial stress experienced by the mother in late pregnancy influences tiny molecular fragments in the newborn’s blood. These fragments, called transfer RNA fragments or tRFs, were considered for many years to be disposable, but have recently been shown to have important biological functions.
Dr. Davis[/caption]
Esa M. Davis, M.D., M.P.H , F.A.A.F.P
Professor of Medicine and Family and Community Medicine
Associate Vice President of Community Health and
Senior Associate Dean of pPopulation Health and Community Medicine
University of Maryland School of Medicine
Dr. Davis joined the U.S. Preventive Services Task Force in January 2021
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Iron is important to overall health, and people need more iron when they are pregnant. This can make pregnant people at increased risk for iron deficiency, which can progress to anemia and cause complications for both moms and their babies. After reviewing the latest available research, the Task Force found that there is not enough evidence on whether pregnant people who do not have signs or symptoms of iron deficiency or anemia should be screened—or take iron supplements—to improve their health or the health of their baby.
The pregnancy brain is often referred to as momnesia or baby brain.
Dr. Nicholson[/caption]
Wanda K. Nicholson, M.D., M.P.H., M.B.A.
Senior Associate Dean for Diversity, Equity, and Inclusion
Professor of Prevention and Community Health
Milken Institute School of Public Health
George Washington University
Vice chair of the U.S. Preventive Services Task Force
MedicalResearch.com: What is the background for this study?
Response: Neural tube defects are when a baby’s spinal cord or brain don’t develop properly during pregnancy, which can cause serious complications including disability and death. The good news is that taking folic acid supplements before and during early pregnancy is proven to help prevent this from happening.
Dr. Callaghan[/caption]
Bridget Callaghan Ph.D.
Assistant Professor of Psychology
UCLA
Dr. Callahan studies interactions between mental and physical health across development.
MedicalResearch.com: What is the background for this study?
Response: A growing body of evidence links the gut microbiome to brain and immune functioning, and changes to that community of microorganisms is likely among the ways that hardship affects children’s socioemotional development.
Limited evidence in humans has demonstrated the adversities experienced prenatally and during early life influence the composition of the gut microbiome, but no studies had examined whether stress experienced in a mother's own childhood could influence the microbiome of the next generation of children.
Dr. Fink[/caption]
Dorothy A. Fink, MD
Deputy Assistant Secretary for Women's Health
Director, Office on Women's Health
US Department of Health & Human Services
Rockville, MD
MedicalResearch.com: What is the background for this study?
Response: Delivery-related mortality in U.S. hospitals has decreased for all racial and ethnic groups, age groups, and modes of delivery while the prevalence of severe maternal mortality (SMM) increased for all patients, with higher rates for racial and ethnic minority patients of any age.
This study specifically looked at inpatient delivery-related outcomes and found a 57% decrease from 2008-2021. The decreasing mortality rates within the inpatient delivery setting demonstrated as statistically significant and a welcome finding for all women.
This study also looked with greater granularity at the impact of race, ethnicity, and age. Mortality for American Indian women decreased 92%, Asian women decreased 73%, Black women decreased 76%, Hispanic women decreased 60%, Pacific Islander women decreased 79%, and White women decreased 40% during the study period.
Dr. Miller[/caption]
Alex P. Miller, PhD
TranSTAR T32 Postdoctoral Fellow
Department of Psychiatry
Washington University School of Medicine
St. Louis, MO
MedicalResearch.com: What is the background for this study?
Response: Adolescent cannabis use is increasing in the United States. Prior research suggests that people who start using cannabis earlier are more likely to engage in problematic use and also experience greater mental health challenges and socioeconomic disadvantages overall. For example, children who begin using cannabis early are more likely to have behavioral problems and disorders and are more less likely to complete school.
In our study, we used data from the Adolescent Brain Cognitive Development (ABCD) Study, which is following nearly 12,000 kids across the nation to track behavior and brain development as well as health from middle childhood to young adulthood. We looked at what factors are associated with the initiation of cannabis use by age 12-14.