History of prepregnancy migraine and migraine phenotype (to a lesser extent) correlated with higher risk for adverse pregnancy outcomes such as gestational hypertension, preeclampsia, and preterm delivery, according to study findings published in Neurology.
Migraine is very common among women who are of reproductive age. However, it’s unclear whether prepregnancy migraine history and migraine phenotype could be useful clinical markers for obstetric risk.
Researchers in the United States at Harvard and the University of Arizona conducted a prospective cohort study, obtaining data from the Nurses’ Health Study II (NHSII) in which 116,429 women registered nurses between the ages of 25 and 42 years completed a baseline questionnaire in 1989. They analyzed this cohort for women with self-reported physician-diagnosed migraine disorders and migraine phenotypes to assess whether these factors contributed to adverse pregnancy outcomes.
Of the 116,429 women participants, 30,555 pregnancies occurred among 19,694 of these participants who did not have any history of cardiovascular disease, cancer, or diabetes. Of these 19,694 women, 2234 (11.3%) reported that they had been diagnosed as having migraine by a physician — 1078 (5.5%) with aura and 1156 (5.9%) without aura. Chronic hypertension and obesity occurred more frequently among women with migraine in this cohort.
The researchers noted that women with prepregnancy migraine demonstrated an increased risk for preeclampsia (relative risk [RR], 1.40; 95% CI, 1.19-1.65), gestational hypertension (RR, 1.28; 95% CI, 1.11-1.48), and preterm delivery (RR, 1.17; 95% CI, 1.05-1.30) compared with women without migraine history.
Prepregnancy migraine history more strongly associated with the development of term preeclampsia after 37 weeks gestation (RR, 1.65; 95% CI, 1.36-1.98) than preterm preeclampsia before 37 weeks gestation (RR, 0.92; 95% CI, 0.65-1.30). Women who had migraine with aura had a higher risk for developing preeclampsia (RR vs no migraine: 1.51; 95% CI, 1.22-1.88) than women with migraine without aura (RR vs no migraine: 1.30; 95% CI, 1.04-1.61).
Across all pregnancies, prepregnancy migraine history more often correlated with preterm delivery between 32 and 37 weeks gestation (RR, 1.20; 95% CI, 1.07-1.35) than very preterm delivery before 32 weeks gestation (RR, 0.97; 95% CI, 0.71-1.34). Women with prepregnancy migraine were more likely to deliver their babies preterm even if their pregnancies were classified as normotensive (not complicated by gestational hypertension or preeclampsia; RR, 1.19; 95% CI, 1.06-1.34).
Contrastingly, the researchers discovered that prepregnancy migraine history did not correlate with low birthweight in neonates (RR, 0.99; 95% CI, 0.85-1.16) or gestational diabetes mellitus (RR, 1.05; 95% CI, 0.91-1.22). They noticed an interesting trend that women who took aspirin regularly (more than 2x/week) prior to pregnancy demonstrated a 45% decreased risk for both preterm delivery (RR, 0.55; 95% CI, 0.35-0.86) and preeclampsia (RR, 1.10; 95% CI, 0.62-1.96).
“Migraine history, and to a lesser extent migraine phenotype, appear to be important considerations in obstetric risk assessment and management,” the researchers noted. “Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine,” they suggested.
Study limitations included a lower prevalence of overall migraine in study participants than in the general population (11% vs. 24%), potential misclassification of migraine diagnosis, and potential recall bias of pregnancy outcomes if recalled up to 10 years after delivery. Additionally, lack of data on preterm delivery subtypes (spontaneous vs iatrogenic vs rupture of membranes), residual confounding factors (genetics, migraine-specific medications), and lack of generalizability outside of non-Hispanic White women with high health literacy due to their training as nurses may have influenced results.
Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies and the United States National Institutes of Health unrelated to the current study. Please see original source for full list of disclosures.
Purdue-Smithe AC, Stuart JJ, Farland LV, et al. Prepregnancy migraine, migraine phenotype, and risk of adverse pregnancy outcomes. Neurology. Published online January 19, 2023. doi:10.1212/WNL.0000000000206831
This article originally appeared on Neurology Advisor