Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine

Abstract

Background Prevalence of migraine is high during the reproductive age. Although migraine often improves during pregnancy, the risk of adverse pregnancy, birth, neonatal, and neurological outcomes in mother and offspring remains poorly understood. Objective To investigate the associations between maternal migraine and risks of adverse pregnancy outcomes in the mother, and birth, neonatal and postnatal outcomes in the offspring. Methods We used Danish population registries to assemble a cohort of pregnancies among women with migraine and an age‐ and conception year‐matched comparison cohort of pregnancies among women without migraine. The study period was 2005‐2012. We computed adjusted prevalence ratios (aPRs) for pregnancy and birth outcomes and adjusted risk ratios (aRRs) for neonatal and postnatal outcomes, adjusting for age, preconception medical history, and preconception reproductive history. Results We identified 22,841 pregnancies among women with migraine and 228,324 matched pregnancies among women without migraine. Migraine was associated with an increased risk of pregnancy‐associated hypertension disorders (aPR: 1.50 [95% confidence interval (CI): 1.39‐1.61]) and miscarriage (aPR: 1.10 [95% CI: 1.05‐1.15]). Migraine was associated with an increased prevalence of low birth weight (aPR: 1.14 [95% CI: 1.06‐1.23]), preterm birth (aPR: 1.21 [95% CI: 1.13‐1.30]) and cesarean delivery (aPR: 1.20 [95% CI: 1.15‐1.25]), but not of small for gestational age offspring (aPR: 0.94 [95% CI: 0.88‐0.99]) and birth defects (aPR: 1.01 [95% CI: 0.93‐1.09]). Offspring prenatally exposed to maternal migraine had elevated risks of several outcomes in the neonatal and postnatal period, including intensive care unit admission (aRR: 1.22 [95% CI: 1.03‐1.45]), hospitalization (aRR: 1.12 [95% CI: 1.06‐1.18]), dispensed prescriptions (aRR: 1.34 [95% CI: 1.24‐1.45]), respiratory distress syndrome (aRR: 1.20 [95% CI: 1.02‐1.42]), and febrile seizures (aRR: 1.27 [95% CI: 1.03‐1.57), but not of death (aRR: 0.67 [95% CI: 0.43‐1.04]) and cerebral palsy (aRR: 1.00 [95% CI: 0.51‐1.94]). Conclusions Women with migraine and their offspring have greater risks of several adverse pregnancy outcomes than women without migraine.

Polypharmacy and comorbidities during pregnancy in a cohort of women with migraine

“…As expected, use of medications before and during pregnancy was considerably higher in our migraine study sample than the general population of pregnant women. During the first trimester, preventive medication use ranged from 10–16%; other studies in similar populations not limited to specific diagnoses noted much lower prevalence (22–24), as did a study among pregnant women with migraine (25). However, the overall pattern of pharmacotherapy discontinuation in our study, with greater discontinuation for preventive drugs and less for acute treatments other than triptans, is consistent with many drug utilization studies in pregnancy in both the US (26,27) and Europe (28).…”

Effect of Migraine on Pregnancy Planning: Insights From the American Registry for Migraine Research

“…24 Offspring prenatally exposed to maternal migraine had elevated risks of intensive care unit admission, dispensed prescriptions, respiratory distress syndrome, and febrile seizures. 23,25 Most of the adjusted risk ratios for adverse fetal outcomes were less than 1.5.…”

“…4,21,22 However, some studies have reported that active migraine is a modest risk factor for poor pregnancy outcomes, such as gestational hypertension, preeclampsia, ischemic stroke, myocardial infarction, deep vein thrombosis, pulmonary embolus, miscarriage, increased prevalence of low birth weight, preterm birth, and cesarean delivery. 23 More severe forms of migraine with frequent attacks during pregnancy may be associated with poorer outcomes. 24 Offspring prenatally exposed to maternal migraine had elevated risks of intensive care unit admission, dispensed prescriptions, respiratory distress syndrome, and febrile seizures.…”

Migraine: navigating the hormonal minefield

“…Several studies have identified associations between migraine and pre-eclampsia or gestational hypertension 36 37. There is some evidence to suggest an increased risk in women with preterm births (OR 1.24) and low birth weight (OR 2.74) 38 39…”