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Alexandra Purdue-Smithe, PhD








Associate Epidemiologist




Alexandra C. Purdue-Smithe, Leslie V. Farland, Jennifer J. Stuart, Jae Hee Kang, Andrea M. Harriott, Kathryn M. Rexrode, Janet W. Rich-Edwards

A prospective study of migraine and aura phenotype and the risk of spontaneous abortion, stillbirth, and ectopic pregnancy

The Women in Medicine and Science Symposium offers an outstanding opportunity to highlight and elevate the important scientific and clinical contributions of women in the MGB community. Moreover, it provides an excellent forum to network and connect with other women researchers and clinicians. As an epidemiologist, my current research interests lie at the intersection of neurological and reproductive health in women. My recent work leverages data from large prospective cohorts to show that pre-pregnancy migraine is a robust clinical risk marker for vascular-mediated obstetric complications including preeclampsia, gestational hypertension, preterm delivery, and late-term pregnancy loss.

Background Migraine is a neurovascular disorder most prevalent among women 18-45 years old (~25%). No prospective studies have examined associations of migraine and aura phenotype with spontaneous abortion, stillbirth, or ectopic pregnancy.

Methods We estimated associations of self-reported physician-diagnosed migraine before pregnancy (14%) and aura phenotype with spontaneous abortion (losses <20 weeks), stillbirth (losses ≥20 weeks), and ectopic pregnancy among incident pregnancies in the prospective Nurses’ Health Study II (n=40,339). Relative risks (RR) and 95% confidence intervals (CI) were estimated using log-binomial regression that accounted for multiple pregnancies per participant.

Results In adjusted models, migraine was modestly associated with overall risk of spontaneous abortion (RR=1.08; 95% CI=1.02-1.15). This association was more prominent for losses occurring during 12-19 weeks’ gestation (RR=1.15; 95% CI=1.01-1.32) than earlier losses (<8 weeks RR=1.04; 95% CI=0.92-1.17; 8-11 weeks RR=1.06; 95% CI=0.95-1.18). The overall risk of spontaneous abortion appeared slightly stronger for migraine with aura (RR=1.12; 95% CI=1.03-1.22) than without aura (RR=1.04; 95% CI=0.96-1.13), compared to no migraine. Migraine was not significantly associated with stillbirth (RR=1.14; 95% CI=0.86-1.52) or ectopic pregnancy (RR=1.31; 95% CI=0.97-1.76), though power for these analyses was limited.

Conclusions Migraine is associated with a modestly higher risk of spontaneous abortion, especially later in gestation.