Migraine could be considered a clinical marker of increased obstetric risk in pregnant women.
Migraines affect up to 3 times as many women as men, especially among younger women aged 18 to 44 years, and during their reproductive years. Investigators discovered that a migraine diagnosis prior to pregnancy was linked with adverse outcomes during pregnancy, in a study recently published in the journal Neurology.
Women who suffer migraine before pregnancy had a 40% higher rate of preeclampsia compared to those without migraine, but low-dose aspirin may be effective against the condition.
“Preterm delivery and hypertensive disorders are some of the primary drivers of maternal and infant morbidity and mortality. Our findings suggest that a history of migraine warrants consideration as an important risk factor for these complications and could be useful in flagging women who may benefit from enhanced monitoring during pregnancy,” said Alexandra Purdue-Smithe, PhD, first author, associate epidemiologist at Brigham and Women's Hospital and instructor in Medicine at Harvard Medical School, in a recent press release.
Approximately 5.5% of those with migraine also experience auras, or visual disturbances prior to headache. Previous studies connected auras with risk of coronary heart disease and ischemic stroke in pregnant women, but there are still not many studies analyzing the risk of migraine and adverse pregnancy outcomes, nor risk of complications by aura phenotype.
This prompted investigators at Brigham and Women’s Hospital, part of the Mass General Brigham health care system, to analyze data from the Nurses’ Health Study 2. The team looked at a large cohort of 19,694 US nurses and 30,555 pregnancies, examining self-reported physician-diagnosed cases of migraine, aura phenotype, and self-reported pregnancy outcome.
The data showed that pre-pregnancy migraine was associated with a 17% increased risk of preterm delivery and 40% higher rate of preeclampsia, along with an increased risk of gestational hypertension compared to patients without migraine. Aura was also found to be associated with a higher risk of preeclampsia.
The Brigham team also observed that women with migraine who took regular aspirin prior to pregnancy had a 45% reduced risk of preterm delivery, “suggest[ing] that aspirin may be beneficial for women with migraine,” said Purdue-Smithe; however, aspirin is not indicated to use among women with migraine during pregnancy.
The study contains some limitations, such as the data were self-reported and only physician-diagnosed migraines were included. The study excluded women with chronic or severe migraine, and it was mainly non-Hispanic White individuals with higher socioeconomic status and health literacy.
Currently, the US Preventative Services Task Force recommends low-dose aspirin for women with a high risk of preeclampsia or those with 1 moderate risk factor for preeclampsia during pregnancy. However, “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 definitively answer this question,” Purdue-Smithe said in the press release.
Brigham and Women’s Hospital. Migraine associated with increased risk for pregnancy complications. News Release. January 31, 2023. February 1, 2023. https://www.eurekalert.org/news-releases/978259