Migraine diagnosed before pregnancy is associated with adverse outcomes during pregnancy

Ladies are disproportionately affected by migraines, particularly throughout their childbearing years. Nevertheless, the connection between migraine and hostile being pregnant outcomes has not been effectively understood. A brand new research performed by investigators from Brigham and Ladies’s Hospital, a founding member of Basic Brigham and Basic Healthcare System, analyzed knowledge from 1000’s of girls from the Nurses’ Well being Examine II to evaluate the connection between migraines and being pregnant issues. In a paper printed in Neurologythe group reported that migraine identified earlier than being pregnant was related to hostile 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 start and hypertensive problems 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 necessary threat issue for this complication and might be helpful in reporting ladies who would possibly profit from enhanced monitoring throughout being pregnant.”

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

Ladies are two to 3 occasions extra seemingly 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 could 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 larger dangers of coronary coronary heart illness and stroke in ladies in line with earlier research. The underlying biology accountable for these dangers may improve the chance of being pregnant issues. However thus far, 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 research inhabitants and the supply of knowledge on different well being and behavioral components, the researchers might management for potential confounding components of their analyses, equivalent to 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 start weight or gestational diabetes.

Members with migraines who reported utilizing aspirin recurrently (greater than twice every week) earlier than being pregnant had been 45 p.c much less prone to have a untimely start. The U.S. Preventive Companies Process Power at present recommends low-dose aspirin throughout being pregnant for people vulnerable 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 be efficient in lowering preterm labor charges. Nevertheless, Purdue-Smithe notes that migraine will not be at present included among the many indications for aspirin use in being pregnant. Our findings of a lowered threat of preterm labor amongst ladies with migraine who reported common aspirin use earlier than being pregnant counsel that aspirin may be helpful for ladies with migraine. Given the observational nature of our research, the dearth of detailed info on aspirin dosage is offered. On set, scientific trials shall be wanted to definitively reply this query.”

Another limitations of the research embody, that individuals had been solely reported if that they had a medical analysis of migraine, and people who didn’t endure from power or extreme migraines had been seemingly excluded. Furthermore, the aura was evaluated after the analysis of migraine and after a number of pregnancies within the group, which can lead to some extent of reverse causation in analyzes inspecting 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 hostile being pregnant outcomes. Neurology. doi.org/10.1212/WNL.0000000000206831.

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