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Migraine may be an important obstetric risk factor

Presented By
Dr Alexandra Purdue-Smithe, Harvard Medical School, MA, USA
Presented by
Alexandra Purdue-Smithe Harvard Medical School
AAN 2022

In a large study evaluating over 30,000 pregnancies between 1989 and 2009, pre-pregnancy migraine had a higher risk of pre-term delivery, gestational hypertension, and pre-eclampsia. Migraine history and phenotype may be important considerations in obstetric risk assessment and management.

Migraine and adverse pregnancy outcomes share a common pathophysiology [1]. “Roughly 20% of women of childbearing age experience migraine, but the impact of migraine on pregnancy outcomes has not been well understood,” said study author Dr Alexandra Purdue-Smithe (Harvard Medical School, MA, USA) [2]. This is due to a lack of large prospective studies. Her group in Boston used data from 30,555 pregnancies in 19,694 participants of the longitudinal Nurses’ Health Study 2 and estimated associations of confirmed migraine before pregnancy with pre-term delivery (<37 weeks), gestational diabetes mellitus (GDM), gestational hypertension, pre-eclampsia, and low birthweight (<5.5 lbs).

Pre-pregnancy migraine was found in 11% of participants. Compared with women without migraine, they had a 17% higher risk of pre-term delivery (RR 1.17; 95% CI 1.05–1.30), a 28% higher risk of gestational hypertension (RR 1.28; 95% CI 1.11–1.48), and a 40% higher risk of pre-eclampsia (RR 1.40; 95% CI 1.19–1.65). Pre-pregnancy migraine was not associated with low birth weight (RR 0.99; 95% CI 0.85–1.16) or GDM (RR 1.05; 95% CI 0.91–1.22). Migraine with aura may be more strongly associated with pre-eclampsia, as the risk of pre-eclampsia was 51% higher (RR 1.51; 95% CI 1.22–1.88) among migraine patients with aura, and 29% higher among migraine patients without aura (RR 1.29; 95% CI 1.04–1.61), when compared with women without migraine. Aspirin use was associated with a lower risk of adverse pregnancy outcomes among women with migraine.

These associations may overall not be very strong, but women with a history of migraine should be aware of potential pregnancy risks, according to Dr Purdue-Smithe. “Women with migraine may benefit from closer monitoring during pregnancy, so that complications like pre-eclampsia can be identified and managed as soon as possible.”

  1. Aukes AM, et al. Obstet Gynecol Surv. 2019;74(12):738‒748.

  2. Purdue-Smithe A, et al. Pre-pregnancy migraine and risk of adverse pregnancy outcomes. S4.003, AAN 2022, 02–07 April, Seattle, USA.

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