Use of existing electronic health care databases to evaluate medication safety in pregnancy: Triptan exposure in pregnancy as a case study

Pharmacoepidemiol Drug Saf. 2018 Dec;27(12):1309-1315. doi: 10.1002/pds.4658. Epub 2018 Sep 21.


Purpose: The recent expansion of electronic health and medical record systems may present an opportunity to generate robust post-approval safety data and obviate the limitations of prospective pregnancy exposure registries. We examined and compared, over the same time frame, the outcomes of triptan exposure in pregnancy using (1) a retrospective claims database and (2) a previously completed pregnancy registry.

Methods: Using the Marketscan database, the risk of major birth defects was ascertained in live-born infants whose birth mothers were exposed to sumatriptan, naratriptan, or sumatriptan/naproxen during pregnancy. The frequencies of outcomes observed were compared with the findings of the 16-year sumatriptan, naratripan, and sumatriptan/naproxen prospective pregnancy registry.

Results: About 5120 pregnancies were identified in the retrospective claims cohort in contrast to 617 included in the prospective registry during the same time frame. The proportion of major birth defects among first-semester sumatriptan exposures was 4.0%, which is exactly the same as the proportion of major birth defects reported for first-semester sumatriptan exposures in the registry. There were very few non-livebirth outcomes in both the claims analyses and registry.

Conclusions: These results confirm broad agreement between the database analysis and the registry regarding the safety of triptans during pregnancy. Of note, the number of triptan-exposed pregnancies identified in this large US database was about 7-fold that included in the prospective registry over the same time frame. The findings of this study support an approach of using existing health care database (s) in the post-approval assessment of medication exposure in pregnancy.

Keywords: health care databases; pharmacoepidemiology; prospective pregnancy registries; safety assessment; triptans.

MeSH terms

  • Abnormalities, Drug-Induced / epidemiology*
  • Abnormalities, Drug-Induced / etiology
  • Administrative Claims, Healthcare / statistics & numerical data
  • Adolescent
  • Adult
  • Databases, Factual / statistics & numerical data
  • Drug Combinations
  • Electronic Health Records / statistics & numerical data
  • Female
  • Humans
  • Infant, Newborn
  • Migraine Disorders / drug therapy*
  • Naproxen
  • Piperidines
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Pregnancy Outcome*
  • Prospective Studies
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Sumatriptan
  • Tryptamines / adverse effects*
  • United States / epidemiology
  • Young Adult


  • Drug Combinations
  • Piperidines
  • Tryptamines
  • sumatriptan-naproxen
  • Naproxen
  • Sumatriptan
  • naratriptan