Women are more susceptible to migraines, especially during childbirth. However, the relationship between migraine and the adverse effects of pregnancy is poorly understood. A new study by researchers at Brigham and Women’s Hospital, a founding member of the Mass General Brigham Health Care System, uses data from thousands of women from the Nurses’ Health Study II to assess the relationship between migraine headaches and pregnancy complications. was analyzed. In a paper published in neurologythe team reported that migraine diagnosed before pregnancy was associated with adverse outcomes during pregnancy, including preterm birth, gestational hypertension, and pre-eclampsia, suggesting that migraine is associated with increased obstetric risk. This suggests that it may be a clinical marker for
Premature birth and hypertensive disorders are some of the major contributors to maternal and infant morbidity and mortality. Our findings suggest that a history of migraine headache deserves consideration as an important risk factor for these complications, flagging women who may benefit from increased monitoring during pregnancy. It may help you stand up.”
Alexandra Purdue-Smithe, PhD, first author, associate epidemiologist at Brigham and Women’s Hospital, medical instructor at Harvard Medical School
Women are two to three times more likely than men to experience migraines in their lifetime, and migraine headaches are most common in women aged 18 to 44. Some people have migraines with aura (5.5% of the population). , a visual disturbance that usually precedes the onset of headache.
Previous studies have consistently associated negative effects of pregnancy and migraine, especially migraine with aura, with an increased risk of coronary heart disease and ischemic stroke in women. The underlying biology responsible for these risks may also increase the likelihood of pregnancy complications. However, to date, only a few small or retrospective studies have examined migraine as a risk factor for pregnancy complications. No prospective studies have examined risk according to the aura phenotype (migraine with or without aura).
Purdue-Smithe and colleagues analyzed data from the large Prospective Nurses’ Health Study II, which included 30,555 pregnancies from 19,694 US nurses. The researchers investigated the incidence of pre-pregnancy physician self-diagnosed migraine and migraine phenotypes (migraine with aura versus migraine without aura) and self-reported pregnancy outcomes.
The large study population and the availability of data on other health and behavioral factors allowed researchers to control for potential confounding factors in their analyses, including BMI, chronic hypertension and smoking.
Researchers found that migraine before pregnancy was associated with a 17% higher risk of preterm birth, a 28% higher rate of gestational hypertension, and a 40% higher rate of pre-eclampsia compared to no migraine. found to be related to Migraine with aura had a somewhat higher risk of pre-eclampsia than migraine without aura. Migraine was not associated with low birth weight or gestational diabetes.
Participants with migraines who used aspirin regularly (more than twice a week) before conception had a 45% lower risk of premature birth. Low-dose aspirin during pregnancy is recommended for those with high and one or more moderate risk factors for pre-eclampsia. Clinical trials have shown that low-dose aspirin during pregnancy is also effective in reducing preterm birth rates. However, Purdue-Smithe now says migraines are not among the indications for aspirin use during pregnancy. “Our finding that migraine women who reported regular aspirin use before pregnancy had a reduced risk of preterm birth suggests that aspirin may also benefit women with migraine. Given the observational nature of our study and the lack of detailed information on aspirin dosing, available in our cohorts, it is difficult to answer this question definitively in the clinical setting. I need a test.”
Other limitations of this study include that participants only reported if they had a physician’s diagnosis of migraine, likely excluding those who did not have chronic or severe migraines. Additionally, aura was assessed after migraine diagnosis and after pregnancies in many of the cohorts, so some degree of reverse causality may occur in analyzes examining migraine phenotypes. In addition, cohort studies predominantly included non-Hispanic whites with relatively high socioeconomic status and health literacy, which may limit generalizability.
Brigham and Women’s Hospital
Purdue Smith, AC, and others. (2023) Migraine in pregnancy, migraine phenotypes, and the risk of adverse pregnancy outcomes. Neurology. doi.org/10.1212/WNL.0000000000206831.