Migraine diagnosed before pregnancy is associated with adverse outcomes during pregnancy

Girls are disproportionately affected by migraines, particularly throughout their childbearing years. Nonetheless, the connection between migraine and adversarial being pregnant outcomes has not been properly understood. A brand new research performed by investigators from Brigham and Girls’s Hospital, a founding member of Normal Brigham and Normal Healthcare System, analyzed information from hundreds of girls from the Nurses’ Well being Examine II to evaluate the connection between migraines and being pregnant problems. In a paper printed in Neurologythe group 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 problems are among the major drivers of maternal and toddler morbidity and mortality. Our findings recommend {that a} historical past of migraine warrants consideration as an essential threat issue for this complication and may very well be helpful in reporting ladies who may profit from enhanced monitoring throughout being pregnant.”

Alexandra Purdue-Smith, PhD, senior writer, senior epidemiologist at Brigham and Girls’s Hospital and teacher in drugs at Harvard Medical Faculty.

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

Antagonistic being pregnant outcomes and migraine, particularly migraine with aura, are persistently related to larger dangers of coronary coronary heart illness and stroke in ladies in accordance with earlier research. The underlying biology answerable for these dangers might also improve the probability of being pregnant problems. However up to now, solely a handful of small or retrospective research have examined migraine as a threat issue for being pregnant problems. No potential research have examined the dangers of the aura phenotype (migraine with and with out aura).

Purdue-Smith and colleagues analyzed information from the Nurses’ Well being Potential Examine II, which included 30,555 pregnancies from 19,694 US nurses. The investigators appeared 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 research inhabitants and the provision of information on different well being and behavioral elements, the researchers might management for potential confounding elements of their analyses, reminiscent of physique mass index, power hypertension, and smoking.

The researchers discovered that migraine earlier than being pregnant was related to a 17 p.c larger threat of preterm labor, a 28 p.c larger price of gestational hypertension, and a 40 p.c larger 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.

Members with migraines who reported utilizing aspirin usually (greater than twice every week) earlier than being pregnant had been 45 p.c much less more likely to have a untimely delivery. The U.S. Preventive Providers Job Power at the moment recommends low-dose aspirin throughout being pregnant for people prone to pre-eclampsia and people with greater than a mean threat issue for pre-eclampsia. Scientific trials have proven that low-dose aspirin throughout being pregnant can also be efficient in lowering preterm labor charges. Nonetheless, Purdue-Smithe notes that migraine will not be at the moment included among the many indications for aspirin use in being pregnant. Our findings of a diminished threat of preterm labor amongst ladies with migraine who reported common aspirin use earlier than being pregnant recommend that aspirin might also be useful for girls with migraine. Given the observational nature of our research, the dearth of detailed data on aspirin dosage is on the market. On set, scientific trials shall be wanted to definitively reply this query.”

Another limitations of the research embody, that contributors had been solely reported if that they had a medical prognosis of migraine, and those that didn’t endure from power or extreme migraines had 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 research 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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