Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2017

Open Access 01-12-2017 | Research article

Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine

Authors: Gerd-Marie Eskerud Harris, Mollie Wood, Malin Eberhard-Gran, Christofer Lundqvist, Hedvig Nordeng

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

Login to get access

Abstract

Background

Few studies have investigated the drug utilization patterns and factors predicting drug use in pregnant women with migraine. This longitudinal drug utilization study aimed to describe patterns of analgesic use in a sample of Norwegian pregnant women according to their migraine history, and to identify predictors for analgesic use among these women.

Methods

Pregnant women giving birth at Akershus University Hospital between 2008 and 2010 were recruited at ultrasound examination in gestational week 17. Data were collected by questionnaires in gestational weeks 17 and 32, and at 8 weeks postpartum, and linked to birth records. Women were grouped into four categories according to migraine history: no migraine history, previous migraine history, recent migraine history (within 1 year prior to pregnancy) and migraine in pregnancy. Patterns of use of analgesics were analyzed descriptively. Multivariable logistic regression was used to identify factors predicting analgesic use.

Results

Out of 1981 women, 5.0% reported having migraine in pregnancy, 13.2% had a recent history of migraine, 11.5% had a previous history of migraine, and 68.8% reported no history of migraine. Analgesic use declined during pregnancy. Many women switched from triptans and non-steroidal anti-inflammatory drugs to paracetamol, which constituted most of the analgesic use. Factors associated with analgesic use included recent migraine history (OR 1.6, 95% CI 1.2–2.2), more severe headache intensity (OR 1.3, 95% CI 1.3–1.4), smoking (OR 1.9, 95% CI 1.1–3.3) and multiparity (OR 1.4, 95% CI 1.1–1.7).

Conclusions

Women with migraine stop or switch medications during pregnancy. Analgesic use in pregnancy is affected by migraine characteristics and intensity, and also by socio-demographic factors. Clinicians should bear this in mind when giving advice on adequate management of migraine in pregnancy and safe analgesic use.
Appendix
Available only for authorised users
Literature
1.
Stovner LJ, Zwart JA, Hagen K, Terwindt GM, Pascual J. Epidemiology of headache in Europe. Eur J Neurol. 2006;13(4):333–45.CrossRef
2.
Allais G, Rolando S, De Lorenzo C, Manzoni GC, Messina P, Benedetto C, d’Onofrio F, Bonavita V, Bussone G. Migraine and pregnancy: an internet survey. Neurol Sci. 2013;34(Suppl 1):S93–9.CrossRef
3.
4.
Amundsen S, Nordeng H, Nezvalova-Henriksen K, Stovner LJ, Spigset O. Pharmacological treatment of migraine during pregnancy and breastfeeding. Nat Rev Neurol. 2015;
5.
Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sandor PS. EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. Eur J Neurol. 2009;16(9):968–81.CrossRef
6.
Nordeng H, Ystrom E, Einarson A. Perception of risk regarding the use of medications and other exposures during pregnancy. Eur J Clin Pharmacol. 2010;66(2):207–14.CrossRef
7.
Twigg MJ, Lupattelli A, Nordeng H: Women’s beliefs about medication use during their pregnancy: a UK perspective. Int J Clin Pharm. 2016;38:968–76.
8.
Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mardby AC, Moretti ME, Drozd M, Panchaud A, Hameen-Anttila K, Rieutord A, et al. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 2014;4(2):e004365.CrossRef
9.
Cleary BJ, Butt H, Strawbridge JD, Gallagher PJ, Fahey T, Murphy DJ. Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women. Pharmacoepidemiol Drug Saf. 2010;19(4):408–17.CrossRef
10.
Odalovic M, Vezmar Kovacevic S, Nordeng H, Ilic K, Sabo A, Tasic L. Predictors of the use of medications before and during pregnancy. Int J Clin Pharm. 2013;35(3):408–16.CrossRef
11.
Mitchell AA, Gilboa SM, Werler MM, Kelley KE, Louik C, Hernandez-Diaz S. Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. Am J Obstet Gynecol. 2011;205(1):51. e51-58CrossRef
12.
Olesen C, Thrane N, Henriksen T, Ehrenstein V, Olsen J. Associations between socio-economic factors and the use of prescription medication during pregnancy. Eur J Clin Pharmacol. 2006;62(7):547–53.CrossRef
13.
Daw JR, Hanley GE, Greyson DL, Morgan SG. Prescription drug use during pregnancy in developed countries: a systematic review. Pharmacoepidemiol Drug Saf. 2011;20(9):895–902.PubMedPubMedCentral
14.
Nezvalova-Henriksen K, Spigset O, Nordeng H. Maternal characteristics and migraine pharmacotherapy during pregnancy: cross-sectional analysis of data from a large cohort study. Cephalalgia. 2009;29(12):1267–76.CrossRef
15.
Källén B, Lygner PE. Delivery Outcome in Women Who Used Drugs for Migraine During Pregnancy With Special Reference to Sumatriptan. Headache. 2001;41(4):351–6.CrossRef
16.
Amundsen S, Ovrebo TG, Amble NM, Poole AC, Nordeng H. Use of antimigraine medications and information needs during pregnancy and breastfeeding: a cross-sectional study among 401 Norwegian women. Eur J Clin Pharmacol. 2016;72(12):1525–35.CrossRef
17.
18.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.CrossRef
19.
Winikur A, Winikur D, Rickels K, Cox DS: Symptoms of emotional distress in a family planning service: stability over a four week period. Br J Psychiatry. 1984;144:395–9.
20.
Nettelbladt P, Hansson L, Stefansson CG, Borgquist L, Nordstrom G. Test characteristics of the Hopkins Symptom Check List-25 (HSCL-25) in Sweden, using the Present State Examination (PSE-9) as a caseness criterion. Soc Psychiatry Psychiatr Epidemiol. 1993;28(3):130–3.CrossRef
21.
Murray D, Cox JL: Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS). J Reprod Infant Psychol. 1990;8:99–107.
22.
Eberhard-Gran M, Eskild A, Tambs K, Schei B, Opjordsmoen S. The Edinburgh Postnatal Depression Scale: validation in a Norwegian community sample. Nord J Psychiatry. 2001;55(2):113–7.CrossRef
23.
Sandanger I, Moum T, Ingebrigtsen G, Dalgard OS, Sorensen T, Bruusgaard D. Concordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I. Soc Psychiatry Psychiatr Epidemiol. 1998;33(7):345–54.CrossRef
24.
Spitzer RL, Williams JB, Kroenke K, Linzer M, de Gruy FV 3rd, Hahn SR, Brody D, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994;272(22):1749–56.CrossRef
25.
Hosmer DW, Lemeshow S: Assessing the Fit of the Model. In: Applied Logistic Regression. 2nd ed. Hoboken: John Wiley & Sons, Inc.; 2000: 143–202.
26.
StataCorp. Stata Statistical Software, vol. 14. College Station: StataCorp LP; 2015.
27.
Baraka MA, Steurbaut S, Coomans D, Dupont AG. Ethnic differences in drug utilization pattern during pregnancy: a cross-sectional study. J Matern Fetal Neonatal Med. 2013;26(9):900–7.CrossRef
28.
Nilsen RM, Vollset SE, Gjessing HK, Skjaerven R, Melve KK, Schreuder P, Alsaker ER, Haug K, Daltveit AK, Magnus P. Self-selection and bias in a large prospective pregnancy cohort in Norway. Paediatr Perinat Epidemiol. 2009;23(6):597–608.CrossRef
29.
Nohr EA, Frydenberg M, Henriksen TB, Olsen J. Does low participation in cohort studies induce bias? Epidemiology. 2006;17(4):413–8.CrossRef
30.
van Gelder MM, van Rooij IA, de Walle HE, Roeleveld N, Bakker MK. Maternal recall of prescription medication use during pregnancy using a paper-based questionnaire: a validation study in the Netherlands. Drug Saf. 2013;36(1):43–54.CrossRef
31.
Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. 3rd ed. London: Academic Press; 2015.
32.
Rasmussen BK, Jensen R, Olesen J. Questionnaire versus clinical interview in the diagnosis of headache. Headache. 1991;31(5):290–5.CrossRef
33.
Schürks M, Buring JE, Kurth T: Agreement of self-reported migraine with ICHD-II criteria in the Women’s Health Study. Cephalalgia. 2009;29:1086–90.
34.
Qiu C, Williams MA, Aurora SK, Peterlin BL, Gelaye B, Frederick IO, Enquobahrie DA. Agreement of self-reported physician diagnosis of migraine with international classification of headache disorders-II migraine diagnostic criteria in a cross-sectional study of pregnant women. BMC Womens Health. 2013;13(1):50.CrossRef
35.
Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38(2):90–6.CrossRef
36.
Werler MM, Mitchell AA, Hernandez-Diaz S, Honein MA. Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol. 2005;193(3 Pt 1):771–7.CrossRef
37.
Brandlistuen RE, Ystrom E, Nulman I, Koren G, Nordeng H. Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study. Int J Epidemiol. 2013;42(6):1702–13.CrossRef
38.
Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. 2014;168(4):313–20.CrossRef
39.
Facchinetti F, Allais G, Nappi RE, D’Amico R, Marozio L, Bertozzi L, Ornati A, Benedetto C. Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study. Cephalalgia. 2009;29(3):286–92.CrossRef
40.
Adeney KL, Williams MA, Miller RS, Frederick IO, Sorensen TK, Luthy DA. Risk of preeclampsia in relation to maternal history of migraine headaches. J Matern Fetal Neonatal Med. 2005;18(3):167–72.CrossRef
41.
Williams MA, Peterlin BL, Gelaye B, Enquobahrie DA, Miller RS, Aurora SK. Trimester-specific blood pressure levels and hypertensive disorders among pregnant migraineurs. Headache. 2011;51(10):1468–82.CrossRef
42.
Bushnell CD, Jamison M, James AH. Migraines during pregnancy linked to stroke and vascular diseases: US population based case–control study. BMJ Open. 2009;338:b664.
43.
Hauth JC, Ewell MG, Levine RJ, Esterlitz JR, Sibai B, Curet LB, Catalano PM, Morris CD. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calcium for Preeclampsia Prevention Study Group. Obstet Gynecol. 2000;95(1):24–8.PubMed
44.
Kristoffersen ES, Lundqvist C. Medication-overuse headache: a review. J Pain Res. 2014;7:367–78.CrossRef
45.
Ystrom E, Vollrath ME, Nordeng H. Effects of personality on use of medications, alcohol, and cigarettes during pregnancy. Eur J Clin Pharmacol. 2012;68(5):845–51.CrossRef
Metadata
Title
Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine
Authors
Gerd-Marie Eskerud Harris
Mollie Wood
Malin Eberhard-Gran
Christofer Lundqvist
Hedvig Nordeng
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1399-0

Other articles of this Issue 1/2017

BMC Pregnancy and Childbirth 1/2017 Go to the issue

Research article

Patterns of gestational diabetes diagnosis inside and outside of clinical guidelines

Research article

“I am a person but I am not a person”: experiences of women living with obstetric fistula in the central region of Malawi

Research article

Prevalence and predictors of early gestational weight gain associated with obesity risk in a diverse Australian antenatal population: a cross-sectional study

Research article

Cesarean deliveries and maternal weight retention

Research article

Increased postpartum haemorrhage, the possible relation with serotonergic and other psychopharmacological drugs: a matched cohort study

Research article

Fathers’ views and experiences of their own mental health during pregnancy and the first postnatal year: a qualitative interview study of men participating in the UK Born and Bred in Yorkshire (BaBY) cohort