Associations Between Migraine and Adverse Pregnancy Outcomes: Systematic Review and Meta-analysis

Abstract

Importance Migraine is a highly prevalent disorder associated with cardiovascular diseases. Cardiovascular diseases are also associated with preeclampsia (PE). The adverse pregnancy outcomes PE, preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA) and placental abruption share aspects in their pathophysiology, which are also found in patients with migraine, such as inflammatory stress and hypercoagulability. Objective To determine the association of adverse pregnancy outcomes including PE, PTB, LBW, SGA, and placental abruption with a history of migraine through a systematic review and meta-analysis. Evidence Acquisition MEDLINE (PubMed), the Cochrane Library, and EMBASE, were searched from inception to November 11, 2018. Cohort studies and case-control studies evaluating migraine history and pregnancy complications were eligible. Results Of 1388 screened references, 14 studies were included in the systematic review. There were higher risks of PE (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.51–2.85; I 2 = 76%) and LBW (OR, 1.18; 95% CI, 1.03–1.34; I 2 = 9%) in women with migraine compared with women without migraine. We observed no significant association between history of migraine and PTB (OR, 1.23; 95% CI, 0.97–1.55; I 2 = 61%) or SGA (OR, 1.06; 95% CI, 0.98–1.15; I 2 = 0%). Conclusions A history of migraine is significantly associated with an increased risk of adverse pregnancy outcomes including PE and LBW. We hypothesize that shared pathophysiology due to underlying preclinical cardiovascular risk in women with migraine might play a role during pregnancy. Relevance Pregnant women with a history of migraine should be considered at higher risk of adverse pregnancy outcomes and should be informed, monitored, and treated preventively accordingly. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to: Describe the association between migraine and placenta-induced pregnancy complications; Explain the possibility of the developing preeclampsia in women with a history of migraine; and Assess the risk of preterm birth or a neonate with low birth weight or small for gestational age in women with migraine.

Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis

“…However, we found that women with migraine appear to have a slightly increased risk of preeclampsia and low birthweight deliveries. 22,36-38 Our findings further illustrated an increased risk of fetal stress, labor and delivery complications, and the presence of a CDC SMM indicator.…”

“…We identified clinical and obstetric factors associated with increased maternal morbidity and mortality from previous studies. 2,[13][14][15][16][17][18][19][20][21][22][23][24] Obstetric characteristics of interest included the validated CDC SMM indicators. 2,13,14,18,25 The 21 SMM indicators include serious labor and delivery outcomes that are identifiable at delivery hospitalization using ICD-10 procedure and diagnosis codes and provide a standardized tool to track acute peripartum complications that may result in significant short-or long-term maternal health sequelae (e.g., cardiac arrest, eclampsia, sepsis).…”

Headaches in Pregnancy and Postpartum

“…Vigilance in the prenatal care provided to patients with a history of migraine is also important because the underlying physiology associated with migraine increases the risk of preeclampsia and other hypertensive disorders (odds ratio [OR] 2.07; 95% CI 1.51–2.85) (21) and (OR 2.85; 95% CI 1.40–5.81) (22) compared with those without migraine. The associated risks of low birthweight (OR 1.18; 95% CI 1.03–1.34) (21) and (OR 1.97; 95% CI 0.98–3.98) (22) as well as preterm birth (OR 1.23; 95% CI 0.97–1.55) (21) and (OR 1.16; 95% CI 1.07–1.24) (23) are less conclusive.…”

De novo migraine with aura in the third trimester of pregnancy: a case report and literature review

“…Altogether, these studies suggest that hypertensive disorders, such as preeclampsia [18] and infections (most commonly viral infections and sinusitis) [4] are the most common causes of SHDs. It is important to emphasize that the hypercoagulable state caused by pregnancy [2,10] and migraine [20] are independent risk factors for preeclampsia, cerebral venous thrombosis, TIA and stroke [8,9]. Two retrospective studies reported that specific clinical findings, so-called "red flags" (Table 3) [4,18], should alarm doctors to investigate for the underlying cause of SHD.…”