From the Division of Women's Health (A.C.P.-S., J.J.S., J.W.R.-E., K.R.) and Channing Division of Network Medicine (J.H.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (J.J.S., J.W.R.-E.), Harvard T.H. Chan School of Public Health, Boston; Department of Epidemiology and Biostatistics (L.V.F.), Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson; Department of Obstetrics and Gynecology (L.V.F.), University of Arizona, College of Medicine, Tucson; and Department of Neurology (A.M.H.), Mass General Hospital and Harvard Medical School, Boston, MA.
Neurology. 2023 Apr 4;100(14):e1464-e1473. doi: 10.1212/WNL.0000000000206831. Epub 2023 Jan 19.
Migraine is a highly prevalent neurovascular disorder among reproductive-aged women. Whether migraine history and migraine phenotype might serve as clinically useful markers of obstetric risk is not clear. The primary objective of this study was to examine associations of prepregnancy migraine and migraine phenotype with risks of adverse pregnancy outcomes.
We estimated associations of self-reported physician-diagnosed migraine and migraine phenotype with adverse pregnancy outcomes in the prospective Nurses' Health Study II (1989-2009). Log-binomial and log-Poisson models with generalized estimating equations were used to estimate relative risks (RRs) and 95% CIs for gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension, preterm delivery, and low birthweight.
The analysis included 30,555 incident pregnancies after cohort enrollment among 19,694 participants without a history of cardiovascular disease, diabetes, or cancer. After adjusting for age, adiposity, and other health and behavioral factors, prepregnancy migraine (11%) was associated with higher risks of preterm delivery (RR = 1.17; 95% CI = 1.05-1.30), gestational hypertension (RR = 1.28; 95% CI = 1.11-1.48), and preeclampsia (RR = 1.40; 95% CI = 1.19-1.65) compared with no migraine. Migraine was not associated with low birthweight (RR = 0.99; 95% CI = 0.85-1.16) or GDM (RR = 1.05; 95% CI = 0.91-1.22). Risk of preeclampsia was somewhat higher among participants with migraine with aura (RR vs no migraine = 1.51; 95% CI = 1.22-1.88) than migraine without aura (RR vs no migraine = 1.30; 95% CI = 1.04-1.61; heterogeneity = 0.32), whereas other outcomes were similar by migraine phenotype. Participants with migraine who reported regular prepregnancy aspirin use had lower risks of preterm delivery (<2×/week RR = 1.24; 95% CI = 1.11-1.38; ≥2×/week RR = 0.55; 95% CI = 0.35-0.86; -interaction < 0.01) and preeclampsia (<2×/week RR = 1.48; 95% CI = 1.25-1.75; ≥2×/week RR = 1.10; 95% CI = 0.62-1.96; -interaction = 0.39); however, power for these stratified analyses was limited.
Migraine history, and to a lesser extent migraine phenotype, appear to be important considerations in obstetric risk assessment and management. Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine.
偏头痛是育龄妇女中一种高发的神经血管疾病。偏头痛病史和偏头痛表型是否可以作为产科风险的临床有用标志物尚不清楚。本研究的主要目的是研究孕前偏头痛和偏头痛表型与不良妊娠结局之间的关联。
我们使用广义估计方程的log-binomial 和 log-Poisson 模型来估计自我报告的经医生诊断的偏头痛和偏头痛表型与不良妊娠结局（妊娠糖尿病、子痫前期、妊娠期高血压、早产和低出生体重）之间的相关性。该研究对护士健康研究 II 队列（1989-2009 年）中 19694 名无心血管疾病、糖尿病或癌症病史的参与者进行了前瞻性分析，共纳入了 30555 例首发妊娠。
在队列入组后，共发生了 30555 例首发妊娠，其中 19694 名参与者无心血管疾病、糖尿病或癌症病史。在调整年龄、肥胖和其他健康及行为因素后，与无偏头痛相比，孕前偏头痛（11%）与早产（RR=1.17；95%CI=1.05-1.30）、妊娠期高血压（RR=1.28；95%CI=1.11-1.48）和子痫前期（RR=1.40；95%CI=1.19-1.65）的风险增加相关。偏头痛与低出生体重（RR=0.99；95%CI=0.85-1.16）或妊娠糖尿病（RR=1.05；95%CI=0.91-1.22）无关。与无偏头痛相比，有先兆偏头痛（RR 与无偏头痛相比=1.51；95%CI=1.22-1.88）参与者发生子痫前期的风险略高，而无先兆偏头痛（RR 与无偏头痛相比=1.30；95%CI=1.04-1.61；异质性=0.32），而其他结局则无差异。有偏头痛且孕前经常服用阿司匹林的参与者早产（<2×/周 RR=1.24；95%CI=1.11-1.38；≥2×/周 RR=0.55；95%CI=0.35-0.86；-交互作用<0.01）和子痫前期（<2×/周 RR=1.48；95%CI=1.25-1.75；≥2×/周 RR=1.10；95%CI=0.62-1.96；-交互作用=0.39）的风险降低，然而这些分层分析的效能有限。
偏头痛病史，以及在较小程度上的偏头痛表型，似乎是产科风险评估和管理中的重要考虑因素。未来的研究应确定阿司匹林预防治疗是否有益于预防有偏头痛病史的孕妇的不良妊娠结局。
