Triptan overuse during pregnancy: a possible cause of placental hypoperfusion
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LETTER TO THE EDITOR
Triptan overuse during pregnancy: a possible cause of placental hypoperfusion Delphine Viard 1
&
Alexandre Gérard 1 & Jellila Tahiri 2 & Nathalie Tieulié 3 & Elise Van Obberghen 1 & Milou-Daniel Drici 1
Received: 23 July 2020 / Accepted: 1 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Sirs, Triptans are serotoninergic agonist drugs with relevant vasoconstrictive properties [1]. They have proved their efficacy in the management of acute migraine attacks, hence the wide use of this class of drugs. Unfortunately, triptan misuse is frequent and risky [2]. Data on triptan use during pregnancy are reassuring regarding teratogenic risk [3, 4]. However, their vasoconstrictive effects might affect pregnancy. Here, we report a case of triptan overuse during pregnancy possibly responsible of placental hypoperfusion with premature birth. A 26-year-old primigravida woman with no medical history except a migraine with aura treated with almotriptan (12.5 mg) presented to her gynecologist for routine follow-up of her pregnancy at 31 + 2 weeks of gestation (WG). While no abnormality was previously detected, the performed ultrasonography revealed a decrease of the growth curve (13th percentile using Hadlock’s formula [5]), a decreased amount of amniotic fluid, a grade II placental calcification, and a left uterine artery notch. Causes and risk factors of fetal growth restriction were researched [6]. The mother had neither gestational diabetes nor hypertension or weight trouble. She did not smoke, drink alcohol, nor consumed any recreational drug. Serologies ruled out a recent maternal infection for Parvovirus B19, Cytomegalovirus, toxoplasmosis, and rubella. The following ultrasounds performed at 33 + 5 WG showed a worsening of the abnormalities including an intrauterine growth restriction with an estimated
* Delphine Viard [email protected] 1
Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France
2
Department of Obstetrics and Gynecology, University Hospital of Nice, Nice, France
3
Department of Rheumatology, University Hospital of Nice, Nice, France
fetal weight of 1.878 g (8th percentile), an oligoamnios, grade III placental calcification, and a left uterine artery notch. Five days later, the woman was hospitalized because of decreased fetal movements. A premature cesarean delivery was performed at 34 + 5 WG. After 24 h of intensive care, the Caucasian baby boy was transferred to a conventional unit and discharged at day 5. During a follow-up consultation, the mother admitted that she had clearly been overusing almotriptan throughout her pregnancy, consuming more than 2 pills per week, with several days of daily administrations during every crisis. She also notified occasional use of paracetamol and esomeprazole with therapeutic and limited doses. She denied haven taking any other drug during pregnancy, especially any nonsteroidal anti-inflammatory drug. The presence of a recurrent uterine artery notch, an oligoamnios, a
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