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 effectively 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 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 group reported that migraine identified 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 medical signal of upper obstetric threat.

Untimely start and hypertensive problems are among 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 drugs at Harvard Medical College.

Girls are two to 3 occasions extra probably 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 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 increased dangers of coronary coronary heart illness and stroke in girls in accordance with earlier research. The underlying biology liable for these dangers can also enhance the probability 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 regarded 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 components, the researchers may management for potential confounding components of their analyses, reminiscent of physique mass index, continual hypertension, and smoking.

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

Contributors with migraines who reported utilizing aspirin repeatedly (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 Providers Job Power presently recommends low-dose aspirin throughout being pregnant for people prone to pre-eclampsia and people with greater than a median threat issue for pre-eclampsia. Medical 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 presently 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 research, the dearth of detailed info on aspirin dosage is accessible. On set, medical trials will probably be wanted to definitively reply this query.”

Another limitations of the research embrace, that contributors had been solely reported if that they had a medical analysis of migraine, and people who didn’t endure from continual or extreme migraines had been probably excluded. Furthermore, the aura was evaluated after the analysis of migraine and after a number of pregnancies within the group, which can lead to a point 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 adversarial being pregnant outcomes. Neurology. doi.org/10.1212/WNL.0000000000206831.

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