Pre-pregnancy migraine and risk of adverse pregnancy outcomes

Principal Investigator: Kathryn Rexrode and Janet Rich-Edwards

Authors: Alexandra Purdue-Smithe, Jennifer J Stuart, Leslie V. Farland, Jae Hee Kang, Stacey Missmer, Kathryn Rexrode, Janet Rich-Edwards
Lay Abstract

Migraine is a severe headache disorder that is 2-3 times more common among women than men. Migraine is particularly common in women of childbearing age (up to 20%), but the impact of migraine on pregnancy outcomes is not well-understood. Women with migraine and those who experience adverse pregnancy outcomes are more likely to have cardiovascular disease later in life. However, it is unclear whether women diagnosed with migraine before pregnancy are more likely to have adverse pregnancy outcomes. In this large study of over 30,000 pregnancies, we found that women who were diagnosed with migraine by their physician before pregnancy were more likely to have pregnancies complicated by high blood pressure in pregnancy and to deliver their baby early, compared to women who were not diagnosed with migraine before pregnancy. In contrast, women with migraine before pregnancy were not more likely to develop diabetes in pregnancy or deliver a baby with low birthweight than women without a migraine diagnosis. Our findings suggest that women with a history of migraine may have a higher risk for certain serious pregnancy complications, and that migraine history may be an important factor for physicians to consider when evaluating pregnancy risks.

Scientific Abstract

Migraine is a highly prevalent (10-20%) neurovascular disorder that is 2-3 times more common in reproductive-age women than men. Migraine and adverse pregnancy outcomes share common pathophysiology, and both are associated with cardiovascular disease. However, prospective studies examining pre-pregnancy migraine and risk of adverse pregnancy outcomes are limited. We estimated associations of self-reported physician-diagnosed pre-pregnancy migraine with preterm delivery (<37 weeks), gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, and low birthweight (<5.5 lbs) among incident pregnancies in the prospective Nurses’ Health Study 2 (n=31,294). Relative risks (RR) and 95% confidence intervals (CI) were estimated using log-binomial regression that accounted for multiple pregnancies per participant. In models adjusted for age, adiposity, and other lifestyle and health factors, women with pre-pregnancy migraine (13%) exhibited higher risks of preterm delivery (RR=1.17; 95% CI=1.05, 1.31), gestational hypertension (RR=1.26; 95% CI=1.09, 1.46), and preeclampsia (RR=1.38; 95% CI=1.17, 1.62) compared to women without pre-pregnancy migraine. Pre-pregnancy migraine was not associated with low birthweight (RR=0.99; 95% CI=0.85, 1.16) or GDM (RR=1.03; 95% CI=0.89, 1.19). Our findings suggest that pre-pregnancy migraine is associated with higher risks of preterm delivery, gestational hypertension, and preeclampsia, and that migraine history may be an important consideration in obstetric risk assessment and management.

Clinical Implications
Women with a history of migraine may have a higher risk for certain serious pregnancy complications. Migraine history may be an important factor for physicians to consider when evaluating pregnancy risks.

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