Gelaye Bizu, Larrabure-Torrealva Gloria T, Qiu Chunfang, Luque-Fernandez Miguel Angel, Peterlin B Lee, Sanchez Sixto E, Williams Michelle A
Department of Epidemiology, Harvard T.H. Chan School School of Public Health Boston, Boston, MA, USA.
Department of Endocrinology, Instituto Nacional Materno Perinatal, Lima, Peru.
Headache. 2015 May;55(5):646-57. doi: 10.1111/head.12571. Epub 2015 Apr 22.
Migraine is associated with a number of cardiometabolic risk factors including abnormalities in lipid metabolism. However, little is known about these associations among pregnant migraineurs. We conducted the present study to evaluate the extent to which altered lipid profiles are associated with history of migraine among pregnant women.
A cohort of 1062 Peruvian women were interviewed at 24-28 weeks of gestation. Migraine status was classified based on the International Classification of Headache Disorders-II diagnostic criteria. Serum lipid concentrations were measured enzymatically using standardized assays. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) as measures of associations of migraine status with varying concentrations of lipids and lipoproteins during pregnancy.
Approximately 18.5% of the study participants were identified as migraineurs (196 of 1062). Maternal serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, and total cholesterol : HDL ratio were all statistically significantly elevated among pregnant migraineurs compared with pregnant non-migraineurs. In multivariate adjusted models, pregnant women with migraine had higher odds of elevated total cholesterol, LDL, and total cholesterol : HDL ratio as compared with pregnant women without migraine. For instance, the AOR and 95% CI for successive quartiles of the total cholesterol associated with history of migraine were Q2 (219-247 mg/dL): 1.05 (0.64-1.70), Q3 (248-281 mg/dL): 1.16 (0.72-1.86), and Q4 (≥282 mg/dL): 1.87 (1.20-2.91) with the lowest quartile (<219 mg/dL) as the referent group (P value for trend = .003). Obese women with elevated total cholesterol (≥282 mg/dL) were more likely to be migraineurs (OR = 3.71; 95% CI 1.58-8.71) as compared with non-obese women with lower total cholesterol (<219 mg/dL). Similar elevated odds of migraine were observed for obese women with elevated LDL cholesterol, elevated triglycerides and high total cholesterol : HDL ratio.
Pregnant migraineurs had elevated odds of dyslipidemia, particularly hypercholesterolemia, elevated LDL, and total cholesterol : HDL ratio as compared with pregnant non-migraineurs. The observed associations were more pronounced among obese migraineurs. Our findings add to the accumulating evidence of adverse cardiometabolic risk profiles among migraineurs and extend these associations to pregnant women.
偏头痛与多种心血管代谢危险因素相关，包括脂质代谢异常。然而，对于妊娠偏头痛患者之间的这些关联知之甚少。我们开展本研究以评估脂质谱改变与孕妇偏头痛病史之间的关联程度。
对1062名秘鲁妇女在妊娠24 - 28周时进行访谈。根据《国际头痛疾病分类第二版》诊断标准对偏头痛状态进行分类。采用标准化检测方法酶法测定血清脂质浓度。多变量逻辑回归用于估计调整后的优势比（AORs）和95%置信区间（CIs），作为妊娠期间偏头痛状态与不同脂质和脂蛋白浓度之间关联的度量指标。
约18.5%的研究参与者被确定为偏头痛患者（1062名中的196名）。与非偏头痛孕妇相比，偏头痛孕妇的母体血清总胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、甘油三酯以及总胆固醇：HDL比值均在统计学上显著升高。在多变量调整模型中，与无偏头痛的孕妇相比，有偏头痛的孕妇总胆固醇、LDL以及总胆固醇：HDL比值升高的几率更高。例如，与偏头痛病史相关的总胆固醇连续四分位数的AOR和95%CI分别为：Q2（219 - 247mg/dL）：1.05（0.64 - 1.70），Q3（248 - 281mg/dL）：1.16（0.72 - 1.86），Q4（≥282mg/dL）：1.87（1.20 - 2.91），以最低四分位数（<219mg/dL）作为参照组（趋势P值 = 0.003）。与总胆固醇较低（<219mg/dL）的非肥胖妇女相比，总胆固醇升高（≥282mg/dL）的肥胖妇女更有可能是偏头痛患者（OR = 3.71；95%CI 1.58 - 8.71）。对于LDL胆固醇升高、甘油三酯升高以及总胆固醇：HDL比值高的肥胖妇女，也观察到类似的偏头痛高几率。
与非偏头痛孕妇相比，偏头痛孕妇血脂异常的几率升高，尤其是高胆固醇血症、LDL升高以及总胆固醇：HDL比值升高。在肥胖偏头痛患者中观察到的这些关联更为明显。我们的研究结果进一步证明了偏头痛患者存在不良心血管代谢风险特征，并将这些关联扩展到了孕妇群体。
