Migraine Linked to Adverse Events in Pregnancy

Pregnant women with acute severe migraine may be at increased risk for adverse birth outcomes.
Pregnant women with acute severe migraine may be at increased risk for adverse birth outcomes.

Researchers have found further evidence demonstrating that pregnant women who seek treatment for acute migraine may experience higher rates of preterm delivery, preeclampsia, and low birth weight compared with the general population.

Tracy B. Grossman, MD, from the Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, and colleagues retrospectively reviewed a database of all inpatient neurology consultations for acute headache in pregnant women at the Jack D. Weiler Hospital of Montefiore Medical Center over a period of 5 years.

Although previous studies have shown that migraine in pregnancy can increase the risk for low birth weight, preterm delivery, preeclampsia, cesarean delivery, and severe nausea and vomiting,1-4 there is little evidence available on how severe migraine in pregnancy that requires emergency treatment affects delivery outcomes. There is also little evidence on how migraine with aura, chronic migraine, and status migrainosus affect delivery outcomes.

The researchers identified 86 pregnant women with acute migraine (mean age, 29.3 [±6.4] years). Of the 86 women, 35 had migraine with aura (40.7%), 12 had chronic migraine (14.0%), and 27 presented in status migrainosus (31.4%).

The pregnant women with migraine had the following rates of complications:

  • At least 1 adverse outcome: 54.7% (41/75; 95% CI, 29.87%-52.13%).
  • Preterm delivery: 28.0% (21/75; 95% CI, 11.78%-30.22%) vs 11.4% in the general population.
  • Preeclampsia: 21.3% (16/75; 95% CI, 7.7%-24.3%) vs 3%-4% in the general population.
  • Cesarean delivery: 30.6% (23/75; 95% CI, 13.48%-32.52) vs 32.7% in the general population. (This may have been lower than the national rate of cesarean delivery because of the participants' high rate of multiparity, which is associated with successful labor induction.)
  • Low birth-weight: 18.7% (14/75; 95% CI 6.15%-21.85%) vs 8.0% in the general population.

Although this study is important because "it is the first audit of migraine treatment in pregnant women in the acute care setting, utilizing established classification, with an examination of associated birth outcomes," limitations are prominent.

The study had a retrospective design and a small sample size, and 12.7% (11/86) of the participants were lost to follow-up. This was also an observational study with no control group of pregnant women who did not present to acute care for migraine, so this may limit generalizations to women whose migraines may be less severe during pregnancy.

A large number of participants also had multiple comorbidities, such as:

  • Obesity with a body mass index >30 kg/m2 (76/86 [88.3%]; of the 76 obese patients, 18 [23.7%] had at least class III obesity [BMI >40 kg/m2])
  • Diabetes mellitus (pregestational; 10/86 [11.6%])
  • Assorted autoimmune disorders (10/86 [11.6%])
  • Nulliparity (26/86 [30.2%])
  • Multiparity (60/86 [69.8%])
  • Psychiatric comorbidities, most commonly self-reported or diagnosed depression (34/86 [39.5%])
  • Seizure disorder (3/86 [3.5%])
  • History of stroke (1/86 [1.2%])
  • Previous gestational diabetes (30/86 [34.9%])
  • Previous preeclampsia (22/86 [25.6%])

The high rate of comorbidities in the study population made it difficult for the researchers to isolate the effect of migraine alone, noting that, "The multiple comorbidities experienced by this patient population elevates the risk of experiencing an adverse birth outcome. It is therefore impossible to...make a definitive conclusion about the risks associated with acute migraine in pregnancy," they wrote.

Nevertheless, this study provides further evidence to support previous findings about the risks migraine poses in pregnancy.

"Although it is unclear if more aggressive migraine treatment or prophylactic medication use during pregnancy would prevent deleterious outcomes, we advocate that early referral to a neurologist is warranted," the authors wrote. "In addition, pregnant patients with active migraine may be candidates for more intensive surveillance, which can be provided by a maternal-fetal-medicine specialist equipped to manage pregnancy complications."

References

  1. Grossman TB, Robbins MS, Govindappagari S, Dayal AK. Delivery outcomes of patients with acute migraine in pregnancy: a retrospective study [published online January 18, 2017]. Headache. doi: 10.1111/head.13023
  2. Chen HM, Chen SF, Chen YH, Lin HC. Increased risk of adverse pregnancy outcomes for women with migraines: A nationwide population-based study. Cephalalgia. 2010;30:433-438.
  3. Banhidy F, Acs N, Horvath-Puho E, Czeizel AE. Pregnancy complications and delivery outcomes in pregnant women with severe migraine. Eur J Obstet Gynecol Reprod Biol. 2006;134:157-163.
  4. Marozio L, Facchinetti F, Allais G, et al. Headache and adverse pregnancy outcomes: A prospective study. Eur J Obstet Gynecol. 2011;161:140-143.
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