Migraine Associated With Adverse Pregnancy Outcomes
Despite the understanding that there is a high prevalence of reproductive-aged women who experience migraine, little is understood about the relationship between migraine and adverse pregnancy outcomes.
Researchers examined the connection between pre-pregnancy migraine and pregnancy, and they found that adverse outcomes occurred.1
To reach their conclusion, the researchers used data from the prospective Nurses’ Health Study II (1989-2009), which included 30,555 pregnancies among 19,694 study participants in the United States. The participants included were without a history of cardiovascular disease, diabetes, or cancer.
Of the 30,555 pregnancies, pre-pregnancy migraine occurred in 11% of the participants, according to the study. After adjusting for age, adiposity, and other health and behavioral factors, pre-pregnancy migraine was linked with higher risks of preterm delivery, gestational hypertension, and preeclampsia when compared with participants without migraine. Further, the researchers discovered that preeclampsia was somewhat higher among migraine with aura than migraine without aura.
Additionally, participants who reported pre-pregnancy aspirin use for migraine had lower risks of preterm delivery and preeclampsia.
"While the risks of these complications are still quite low overall, women with a history of migraine should be aware of and consult with their doctor on potential pregnancy risks," said Alexandra Purdue-Smithe, PhD, of Brigham and Women's Hospital in Boston, in a press release.2 "More research is needed to determine exactly why migraine may be associated with higher risks of complications. In the meantime, women with migraine may benefit from closer monitoring during pregnancy so that complications like preeclampsia can be identified and managed as soon as possible."
Several limitations were reported including the likelihood of participants who did not have chronic or severe migraines being excluded from the study as participants only reported a diagnosis from a physician. Further, regarding the use of aspirin to manage migraine pain, the study lacked detailed information on aspirin dosage. The generalizability of the study was limited as the cohort study predominately consisted of non-Hispanic White individuals.
Despite the limitations, the researchers believe the study calls for physicians to consider the risks associated with migraine and pregnancy.
“Migraine history, and to a lesser extent migraine phenotype, appear to be important considerations in obstetric risk assessment and management,” the researchers concluded. “Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine.”
The study was supported by the National Institutes of Health.
- Purdue-Smith 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
- Is migraine tied to complications in pregnancy? News release. ScienceDaily; February 25, 2022. Accessed February 14, 2023. www.sciencedaily.com/releases/2022/02/220225123447.htm