Migraine and adverse pregnancy outcomes: the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be

Miller, Eliza C.; Chau, Kristi; Mammadli, Gular; Levine, Lisa D.; Grobman, William A.; Wapner, Ronald J.; Bello, Natalie A.

doi:10.1016/j.ajog.2022.04.049

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…Previous epidemiologic literature, largely limited to case-control and retrospective registry studies, suggests 1.2–6.7-fold higher odds of preeclampsia and gestational hypertension with migraine. 21-25, 27-29, 31, 33, 34 The observed 28% and 40% higher risks of gestational hypertension and preeclampsia, respectively, associated with migraine in our data are compatible with previously reported estimates but extend the literature in several notable ways. Our findings of particularly high risk of term preeclampsia associated with migraine are novel because previous studies did not cross-classify preterm delivery and preeclampsia.…”

Section: Discussionsupporting

confidence: 93%

“…Fewer studies have examined migraine and preterm delivery, and results are conflicting. [20][21][22]26,33,34 Our observed 17% increased risk of preterm delivery among individuals with prepregnancy migraine is most consistent in direction and magnitude with the Danish and Taiwanese register studies, 22,33 whereas 2 smaller prospective studies reported stronger positive associations 26,34 and 2 others reported no association with overall, 21 spontaneous, or medically indicated preterm delivery. 20 As with migraine and HDP, these studies lacked information on important prepregnancy confounders, a limitation more fully addressed by our analysis, and which may explain the higher magnitudes of association observed previously.…”

Section: Discussionsupporting

confidence: 77%

“…Some epidemiologic studies, though not all, have reported positive associations of migraine and adverse pregnancy outcomes including gestational diabetes mellitus (GDM), HDP, preterm delivery, and low birthweight. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Most of the existing literature is limited to case-control studies prone to selection and recall biases, or retrospective registry-based studies that defined migraine status through migraine-related hospitalization or migraine-specific prescriptions. 22,23,25,[27][28][29][30][31][32][33] A few, mostly small, prospective studies reported variable associations of migraine or migraine comorbidities with HDP, 19,21,24,34 preterm delivery (overall, spontaneous, and medically indicated), 20,21,34 and low birthweight, 21 but incompletely adjusted for important prepregnancy confounders such as body mass index (BMI), analgesic use, chronic hypertension, and/or oral contraceptive use.…”

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confidence: 99%

“…[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Most of the existing literature is limited to case-control studies prone to selection and recall biases, or retrospective registry-based studies that defined migraine status through migraine-related hospitalization or migraine-specific prescriptions. 22,23,25,[27][28][29][30][31][32][33] A few, mostly small, prospective studies reported variable associations of migraine or migraine comorbidities with HDP, 19,21,24,34 preterm delivery (overall, spontaneous, and medically indicated), 20,21,34 and low birthweight, 21 but incompletely adjusted for important prepregnancy confounders such as body mass index (BMI), analgesic use, chronic hypertension, and/or oral contraceptive use. Finally, the relationship between migraine with aura, the phenotype most strongly associated with vascular risk, and adverse pregnancy outcomes has not yet been examined in a prospective study.…”

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confidence: 99%

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Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes

et al. 2023

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Background and Objective:Migraine is a highly prevalent neurovascular disorder among reproductive-aged women. Whether migraine history and migraine phenotype might serve as clinically useful markers of obstetric risk is not clear. The primary objective of this study was to examine associations of pre-pregnancy migraine and migraine phenotype with risks of adverse pregnancy outcomes.Methods:We estimated associations of self-reported physician-diagnosed migraine and migraine phenotype with adverse pregnancy outcomes in the prospective Nurses’ Health Study II (1989-2009). Log-binomial and log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI) for gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension, preterm delivery, and low birthweight.Results:The analysis included 30,555 incident pregnancies after cohort enrollment among 19,694 participants without a history of cardiovascular disease, diabetes, or cancer. After adjusting for age, adiposity, and other health and behavioral factors, pre-pregnancy migraine (11%) was associated with higher risks of preterm delivery (RR=1.17; 95% CI=1.05, 1.30), gestational hypertension (RR=1.28; 95% CI=1.11, 1.48), and preeclampsia (RR=1.40; 95% CI=1.19, 1.65) compared to no migraine. Migraine was not associated with low birthweight (RR=0.99; 95% CI=0.85, 1.16) or GDM (RR=1.05; 95% CI=0.91, 1.22). Risk of preeclampsia was somewhat higher among participants with migraine with aura (RR versus no migraine=1.51; 95% CI=1.22, 1.88) than migraine without aura (RR versus no migraine=1.30; 95% CI=1.04, 1.61;P-heterogeneity=0.32), whereas other outcomes were similar by migraine phenotype. Participants with migraine who reported regular pre-pregnancy aspirin use had lower risks of preterm delivery (<2x/wk RR=1.24; 95% CI=1.11, 1.38; ≥2x/wk RR=0.55; 95% CI=0.35, 0.86;P-interaction <0.01) and preeclampsia (<2x/wk RR=1.48; 95% CI=1.25, 1.75; ≥2x/wk RR=1.10; 95% CI=0.62, 1.96;P-interaction=0.39); however, power for these stratified analyses was limited.Conclusions:Migraine history, and to a lesser extent migraine phenotype, appear to be important considerations in obstetric risk assessment and management. Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 77%

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confidence: 99%

mentioning

confidence: 99%

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Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes

et al. 2023

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“…

We thank the reader for these thoughtful comments regarding our analysis of migraine and adverse pregnancy outcomes (APOs) in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b). 1 We agree that the underlying pathway linking migraine to APOs, including hypertensive disorders of pregnancy and preterm birth, is complex and incompletely understood. Migraine with aura is indeed linked to changes in cerebral vasoreactivity and an increased risk of thromboembolic events.

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confidence: 88%