Pregnant women with a history of pre-pregnancy migraine are at higher risk of adverse pregnancy outcomes such as preterm delivery, gestational hypertension and preeclampsia compared to those who do not have a history of migraine, suggests a study published April 4, 2023 in the journal Neurology.¹

To examine the association between pre-pregnancy migraine and adverse pregnancy outcomes such as gestational hypertension, pre-eclampsia, gestational diabetes, low birthweight and preterm delivery, researchers at Brigham and Womens Hospital and Harvard Medical School in Boston obtained data from the Nurses Health Study II. Pregnancies with at least 20 weeks of gestation without a history of heart disease, type 2 diabetes and cancer were included in the analysis, which amounted to 30,555 pregnancies in 19,694 women. Of these, 11% had a physician diagnosed migraine at the time of their enrolment in the present study.

After adjusting for age, BMI and other factors such as chronic hypertension, alcohol consumption, physical activity, smoking status, analgesic use, oral contraceptive use, age at pregnancy, age at onset of menstruation, women with a history of prepregnancy migraine were at 17% greater risk of preterm delivery with relative risk (RR) of 1.17 than women with no migraine. They were also 28% more likely to have gestational hypertension (RR 1.28) and 40% more likely to have preeclampsia (RR 1.40). But no such association was noted for gestational diabetes (RR 1.05) or low birthweight (RR 0.99).

They also sought to determine if the migraine phenotype had any impact on these associations and if the use of aspirin modified this effect. It was found that women who experienced aura with migraine (RR vs no migraine 1.51) were at a greater risk of preeclampsia than women who had migraine without aura (RR vs no migraine 1.30). No differences were observed for other outcomes such as gestational hypertension based on migraine phenotype i.e., migraine with and without aura.

Women who regularly used aspirin for migraine before becoming pregnant were at a lower risk of preterm delivery and preeclampsia. The relative risk for preterm delivery among women who used aspirin less than 2 times in a week was 1.24 and those who used it more than 2 times in a week reduced their risk by half with a relative risk of 0.55. For preeclampsia, the relative risk was 1.48 among women who used aspirin less than 2 times in a week and 1.10 among those who used it ≥2 times in a week.

These findings highlight the significance of eliciting a history of migraine, especially migraine with aura, as part of “obstetric risk assessment and management”. Women with a prepregnancy history of migraine merit close observation throughout the course of the pregnancy for development of hypertensive disorders of pregnancy. “Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine,” the researchers concluded.

Reference

1. Purdue-Smithe AC, et al. Prepregnancy migraine, migraine phenotype, and risk of adverse pregnancy outcomes. Neurology. Apr 2023;100(14):e1464-e1473; DOI: 10.1212/WNL.0000000000206831.