Migraine diagnosed before pregnancy is associated with adverse outcomes during pregnancy

Girls are disproportionately affected by migraines, particularly throughout their childbearing years. Nevertheless, the connection between migraine and adversarial being pregnant outcomes has not been nicely understood. A brand new examine performed by investigators from Brigham and Girls’s Hospital, a founding member of Normal Brigham and Normal Healthcare System, analyzed knowledge from hundreds of ladies from the Nurses’ Well being Examine II to evaluate the connection between migraines and being pregnant issues. In a paper revealed in Neurologythe workforce reported that migraine recognized earlier than being pregnant was related to adversarial outcomes throughout being pregnant, together with untimely supply, gestational hypertension, and pre-eclampsia, suggesting that migraine could also be a scientific signal of upper obstetric threat.

Untimely delivery and hypertensive issues are a few of the major drivers of maternal and toddler morbidity and mortality. Our findings counsel {that a} historical past of migraine warrants consideration as an vital threat issue for this complication and could possibly be helpful in reporting girls who may profit from enhanced monitoring throughout being pregnant.”

Alexandra Purdue-Smith, PhD, senior creator, senior epidemiologist at Brigham and Girls’s Hospital and teacher in medication at Harvard Medical College.

Girls are two to a few instances extra possible than males of their lifetime to expertise a migraine, and migraines are most prevalent amongst girls between the ages of 18 and 44. For some, migraine might be accompanied by an aura (5.5% of the inhabitants), which is often a visible disturbance that seems earlier than the onset of the headache.

Antagonistic being pregnant outcomes and migraine, particularly migraine with aura, are constantly related to greater dangers of coronary coronary heart illness and stroke in girls based on earlier research. The underlying biology chargeable for these dangers can also improve the chance of being pregnant issues. However to date, solely a handful of small or retrospective research have examined migraine as a threat issue for being pregnant issues. No potential research have examined the dangers of the aura phenotype (migraine with and with out aura).

Purdue-Smith and colleagues analyzed knowledge from the Nurses’ Well being Potential Examine II, which included 30,555 pregnancies from 19,694 US nurses. The investigators seemed on the migraine and migraine phenotype (migraine with and with out aura) self-reported earlier than being pregnant and the incidence of self-reported being pregnant outcomes.

Due to the massive dimension of the examine inhabitants and the provision of knowledge on different well being and behavioral components, the researchers may management for potential confounding components of their analyses, reminiscent of physique mass index, persistent hypertension, and smoking.

The researchers discovered that migraine earlier than being pregnant was related to a 17 p.c greater threat of preterm labor, a 28 p.c greater price of gestational hypertension, and a 40 p.c greater price of preeclampsia than with out migraine. Migraine with aura was related to a barely elevated threat of pre-eclampsia in contrast with migraine with out aura. Migraine was not related to low delivery weight or gestational diabetes.

Contributors with migraines who reported utilizing aspirin often (greater than twice per week) earlier than being pregnant have been 45 p.c much less more likely to have a untimely delivery. The U.S. Preventive Companies Job Power at the moment recommends low-dose aspirin throughout being pregnant for people susceptible to pre-eclampsia and people with greater than a mean threat issue for pre-eclampsia. Medical trials have proven that low-dose aspirin throughout being pregnant can also be efficient in decreasing preterm labor charges. Nevertheless, Purdue-Smithe notes that migraine just isn’t at the moment included among the many indications for aspirin use in being pregnant. Our findings of a lowered threat of preterm labor amongst girls with migraine who reported common aspirin use earlier than being pregnant counsel that aspirin can also be helpful for girls with migraine. Given the observational nature of our examine, the shortage of detailed info on aspirin dosage is out there. On set, scientific trials can be wanted to definitively reply this query.”

Another limitations of the examine embody, that individuals have been solely reported if they’d a medical prognosis of migraine, and people who didn’t undergo from persistent or extreme migraines have been possible excluded. Furthermore, the aura was evaluated after the prognosis of migraine and after a number of pregnancies within the group, which can lead to a point of reverse causation in analyzes analyzing the migraine phenotype. As well as, the cohort examine consisted of predominantly white, non-Hispanic people with comparatively excessive socioeconomic standing and well being literacy, which can restrict generalizability.


Journal reference:

Purdue Smith, AC, et al. (2023) Being pregnant, migraine, migraine phenotype, and threat of adversarial being pregnant outcomes. Neurology. doi.org/10.1212/WNL.0000000000206831.

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