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Grand Rounds

Are Migraines a Risk Factor for Adverse Pregnancy Outcomes?

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BACKGROUND AND PURPOSE:

  • Miller et al. (AJOG, 2022) assessed whether self-reported migraine in nulliparous individuals is associated with higher odds of a suite of adverse pregnancy outcomes

METHODS:

  • Prospective, multicenter cohort study
    • Data derived from Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b)
    • Pregnant women followed prospectively through delivery
  • Participants
    • Nulliparous, singleton pregnancies
  • Exposures
    • History of migraines, as assessed by questionnaire
  • Study design
    • Logistic regression models used to estimate odds ratio (OR) and 95% CI for the association of migraine with adverse pregnancy outcomes (APO)
    • Adjusted for demographic characteristics
    • Sensitivity analyses were also performed
  • Primary outcome
    • APO, defined as ≥1 of the following outcomes
      • Gestational hypertension | Preeclampsia or eclampsia | Preterm birth (medically indicated or spontaneous) | Small for gestational age at birth | Stillbirth

RESULTS:

  • 9450 participants
    • History of migraine: 19.1% of participants
    • Exposure groups did not differ for the following
      • Age | Income level | BMI 
    • Migraine was associated with higher proportions of
      • Self-identified White race | Recent smoking history | Autoimmune disorders | Chronic kidney disease
  • Participants with migraine had increased odds of any APO
    • aOR 1.26 (95% CI, 1.12 to 1.41)
  • For individual adverse outcomes, participants with migraine had higher odds of
    • Any hypertensive disorders of pregnancy
    • Medically indicated and spontaneous preterm birth
  • Migraine was not associated with
    • Small for gestational age
    • Stillbirth
  • Sensitivity analyses showed a larger effect in participants who reported recent migraine medication use
    • aOR 1.49 (95% CI, 1.18 to 1.88)

CONCLUSION:

  • A history of migraine was associated with a higher risk of any adverse pregnancy outcome
  • The authors state

In a diverse, prospective cohort of 9450 nulliparous US participants, self-reported migraine headaches were associated with 26% higher odds of APO—an effect driven by HDP and both medically indicated and spontaneous PTB

Migraine may be an underrecognized risk factor for APO

Learn More – Primary Sources:

Migraine and adverse pregnancy outcomes: the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be

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Related ObG Topics:

Antenatal Migraine, Preeclampsia and Risk for Maternal Stroke
What are the Consequences of Taking Triptan for Migraine During Pregnancy?
The New Migraine Medication: Is Rimegepant Effective?
Cochrane Review: What is the Evidence for the Prevention of Migraines Using Botulinum toxins?

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