#propranolol Tag

13 Oct

Posted at 19:26h in Author Interviews, JAMA, Neurology, OBGYNE

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.