Women with prepregnancy migraine had a greater risk of complications

Migraine history may be marker of pregnancy complications.

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Women are two to three times likelier than men to experience migraine. Significantly, among women of reproductive age, migraine is a very common neurovascular disorder. It is unclear if migraine phenotype and history could act as therapeutically relevant indicators of obstetric risk.

A new study at Brigham and Women’s Hospital examines associations of prepregnancy migraine and migraine phenotype with risks of adverse pregnancy outcomes. Scientists demonstrate that women with prepregnancy migraine had a greater risk of complications, including preterm delivery, gestational hypertension, and pre-eclampsia.

Findings imply that a migraine history should be considered a significant risk factor for these issues and may help identify pregnant women who may benefit from enhanced monitoring.

For the study, scientists analyzed data from thousands of women from the Nurses’ Health Study II to assess the relationship between migraine and pregnancy complications. According to the research team, migraine identified before becoming pregnant is associated with unfavorable results, suggesting that the disease may be a clinical indicator of high obstetric risk.

The large, prospective Nurses’ Health Study II included data from 30,555 pregnancies from 19,694 U.S. nurses. Scientists examined the prevalence of self-reported pregnancy outcomes and prepregnancy self-reported physician-diagnosed migraine and migraine phenotype (migraine with and without aura).

Scientists found that prepregnancy migraine was associated with a 17 percent higher risk of preterm delivery, a 28 percent higher rate of gestational hypertension, and a 40 percent higher rate of pre-eclampsia than no migraine. Migraine with aura was associated with a higher risk of pre-eclampsia than migraine without aura. Migraine was not related to low birth weight or gestational diabetes mellitus.

Scientists noted, “Participants with migraine who reported regular aspirin use (more than twice weekly) before pregnancy had a 45 percent lower risk for preterm delivery. The U.S. Preventive Services Task Force currently recommends low-dose aspirin during pregnancy for individuals at high risk of pre-eclampsia and those who have more than one moderate risk factor for pre-eclampsia.”

“Clinical trials have shown that low-dose aspirin during pregnancy also reduces rates of preterm birth. However, Purdue-Smithe notes that migraine is currently not included among indications for aspirin use in pregnancy.”

First author Alexandra Purdue-Smithe, associate epidemiologist at Brigham and Women’s Hospital and instructor in medicine at Harvard Medical School, said“Our findings of reduced risk of preterm delivery among women with migraine who reported regular aspirin use before pregnancy suggests that aspirin may also be beneficial for women with migraine. Given the observational nature of our study, and the lack of detailed information on aspirin dosage available in the cohort, clinical trials will be needed to answer this question definitively.”

Journal Reference:

  1. Alexandra C Purdue-Smithe, Jennifer J Stuart et al. Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes. Neurology DOI: 10.1212/WNL.0000000000206831
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