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

Abstract

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.

History of maternal migraine and its association with preeclampsia: A case–control study in a low-resource setting in Sudan, Africa

“…Chen et al, in a three-year nationwide population-based database study in Taiwan, found that pregnant women who had migraines had a 1.34 times higher risk of preeclampsia than pregnant women who did not have migraine (8). As mentioned earlier, migraine is associated with an elevated risk of hypertensive disorders of pregnancy (6,7,(11)(12)(13).…”

“…Previously, Facchinetti et al (17), in a study involving a large prospective cohort of 702 Italian women with singleton pregnancies, reported that migraine was associated with preeclampsia. In another large cohort study (19,694 participants), women who had pre-pregnancy migraine were found to have a 60.0% higher risk of preeclampsia (relative risk ¼ 1.40) than those who did not have pre-pregnancy migraine (6). A recent systematic review that included 14 studies revealed that pregnant women who had migraines had a 2.07 times higher risk of having preeclampsia than pregnant women who did not have migraine (9).…”

“…Women-especially during their reproductive yearsare more susceptible to migraines, and it has been estimated that approximately 20.0% of women of reproductive age have migraines (5). Pregnant women who have migraines are at higher risk of adverse pregnancy and neonatal outcomes, such as preterm birth (6)(7)(8), low birthweight deliveries (8,9), increased rate of cesarean deliveries (8), increased rate of neonatal intensive care unit admissions, and newborn respiratory distress syndrome (10). Previous studies have reported different levels of association between migraine, hypertensive disorders of pregnancy (6,7,(11)(12)(13), and preeclampsia (6,8,9,(14)(15)(16)(17).…”

“…Pregnant women who have migraines are at higher risk of adverse pregnancy and neonatal outcomes, such as preterm birth (6)(7)(8), low birthweight deliveries (8,9), increased rate of cesarean deliveries (8), increased rate of neonatal intensive care unit admissions, and newborn respiratory distress syndrome (10). Previous studies have reported different levels of association between migraine, hypertensive disorders of pregnancy (6,7,(11)(12)(13), and preeclampsia (6,8,9,(14)(15)(16)(17). Furthermore, most-if not all-of these studies were conducted in high-income countries, and there are no published data on migraine and its association with preeclampsia in Africa.…”

Adverse Pregnancy Outcomes and Migraine

“…The limited knowledge pertaining to migraine and pregnancy outcomes makes it difficult to counsel patients or improve the management of pregnant women with migraine. In this issue of Neurology ®, Purdue-Smithe et al 6 publish a study that evaluates the association of prepregnancy migraine and migraine phenotype (i.e., with or without aura) and the risks of adverse pregnancy outcomes, including gestational diabetes mellitus, preeclampsia, gestational hypertension, preterm delivery, and low birthweight in a prospective cohort of nurses in the United States. The authors used data from the Nurses' Health Study II, which started surveys in 1989 and followed with biennial questionnaires.…”