TY - JOUR
T1 - Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes
AU - Purdue-Smithe, Alexandra C.
AU - Stuart, Jennifer J.
AU - Farland, Leslie V.
AU - Kang, Jae H.
AU - Harriott, Andrea M.
AU - Rich-Edwards, Janet W.
AU - Rexrode, Kathryn
N1 - Funding Information:
A.C. Purdue-Smithe reports no disclosures. J.J. Stuart reports support from the US National Institutes of Health unrelated to this work. L.V. Farland reports support from the US National Institutes of Health unrelated to this work. A.M. Harriott reports support from the US National Institutes of Health unrelated to this work, an authorship agreement with Abbvie unrelated to the present study, honoraria from the Headache Cooperative of New England, participation in the DSMB for the MindfulRAVANS, and leadership roles at the American Academy of Neurology, American Headache Society, and Headache Cooperative of New England. J.H. Kang reports support from the US National Institutes of Health and Pfizer, Inc. unrelated to this work. J.W. Rich-Edwards reports support from the US National Institutes of Health unrelated to this work. K.M. Rexrode reports support from the US National Institutes of Health unrelated to this work and a leadership role at the American Heart Association. Go to Neurology.org/N for full disclosures.
Funding Information:
This work was supported by the National Institutes of Health (U01 CA176726 and U01 HL145386). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.
Publisher Copyright:
© American Academy of Neurology.
PY - 2023/4/4
Y1 - 2023/4/4
N2 - Background and ObjectiveMigraine is a highly prevalent neurovascular disorder among reproductive-Aged women. Whether migraine history and migraine phenotype might serve as clinically useful markers of obstetric risk is not clear. The primary objective of this study was to examine associations of prepregnancy migraine and migraine phenotype with risks of adverse pregnancy outcomes.MethodsWe estimated associations of self-reported physician-diagnosed migraine and migraine phenotype with adverse pregnancy outcomes in the prospective Nurses' Health Study II (1989-2009). Log-binomial and log-Poisson models with generalized estimating equations were used to estimate relative risks (RRs) and 95% CIs for gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension, preterm delivery, and low birthweight.ResultsThe analysis included 30,555 incident pregnancies after cohort enrollment among 19,694 participants without a history of cardiovascular disease, diabetes, or cancer. After adjusting for age, adiposity, and other health and behavioral factors, prepregnancy migraine (11%) was associated with higher risks of preterm delivery (RR = 1.17; 95% CI = 1.05-1.30), gestational hypertension (RR = 1.28; 95% CI = 1.11-1.48), and preeclampsia (RR = 1.40; 95% CI = 1.19-1.65) compared with no migraine. Migraine was not associated with low birthweight (RR = 0.99; 95% CI = 0.85-1.16) or GDM (RR = 1.05; 95% CI = 0.91-1.22). Risk of preeclampsia was somewhat higher among participants with migraine with aura (RR vs no migraine = 1.51; 95% CI = 1.22-1.88) than migraine without aura (RR vs no migraine = 1.30; 95% CI = 1.04-1.61; p-heterogeneity = 0.32), whereas other outcomes were similar by migraine phenotype. Participants with migraine who reported regular prepregnancy aspirin use had lower risks of preterm delivery (<2×/week RR = 1.24; 95% CI = 1.11-1.38; ≥2×/week RR = 0.55; 95% CI = 0.35-0.86; p-interaction < 0.01) and preeclampsia (<2×/week RR = 1.48; 95% CI = 1.25-1.75; ≥2×/week RR = 1.10; 95% CI = 0.62-1.96; p-interaction = 0.39); however, power for these stratified analyses was limited.DiscussionMigraine history, and to a lesser extent migraine phenotype, appear to be important considerations in obstetric risk assessment and management. Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine.
AB - Background and ObjectiveMigraine is a highly prevalent neurovascular disorder among reproductive-Aged women. Whether migraine history and migraine phenotype might serve as clinically useful markers of obstetric risk is not clear. The primary objective of this study was to examine associations of prepregnancy migraine and migraine phenotype with risks of adverse pregnancy outcomes.MethodsWe estimated associations of self-reported physician-diagnosed migraine and migraine phenotype with adverse pregnancy outcomes in the prospective Nurses' Health Study II (1989-2009). Log-binomial and log-Poisson models with generalized estimating equations were used to estimate relative risks (RRs) and 95% CIs for gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension, preterm delivery, and low birthweight.ResultsThe analysis included 30,555 incident pregnancies after cohort enrollment among 19,694 participants without a history of cardiovascular disease, diabetes, or cancer. After adjusting for age, adiposity, and other health and behavioral factors, prepregnancy migraine (11%) was associated with higher risks of preterm delivery (RR = 1.17; 95% CI = 1.05-1.30), gestational hypertension (RR = 1.28; 95% CI = 1.11-1.48), and preeclampsia (RR = 1.40; 95% CI = 1.19-1.65) compared with no migraine. Migraine was not associated with low birthweight (RR = 0.99; 95% CI = 0.85-1.16) or GDM (RR = 1.05; 95% CI = 0.91-1.22). Risk of preeclampsia was somewhat higher among participants with migraine with aura (RR vs no migraine = 1.51; 95% CI = 1.22-1.88) than migraine without aura (RR vs no migraine = 1.30; 95% CI = 1.04-1.61; p-heterogeneity = 0.32), whereas other outcomes were similar by migraine phenotype. Participants with migraine who reported regular prepregnancy aspirin use had lower risks of preterm delivery (<2×/week RR = 1.24; 95% CI = 1.11-1.38; ≥2×/week RR = 0.55; 95% CI = 0.35-0.86; p-interaction < 0.01) and preeclampsia (<2×/week RR = 1.48; 95% CI = 1.25-1.75; ≥2×/week RR = 1.10; 95% CI = 0.62-1.96; p-interaction = 0.39); however, power for these stratified analyses was limited.DiscussionMigraine history, and to a lesser extent migraine phenotype, appear to be important considerations in obstetric risk assessment and management. Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine.
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U2 - 10.1212/WNL.0000000000206831
DO - 10.1212/WNL.0000000000206831
M3 - Article
C2 - 36657989
AN - SCOPUS:85151880396
SN - 0028-3878
VL - 100
SP - E1464-E1473
JO - Neurology
JF - Neurology
IS - 14
ER -