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Among pregnant women, those with migraine have increased risk of vascular events, findings show

Friday, April 17 2009 | Comments

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What's This? Women who experience migraine during pregnancy are more likely to also experience certain vascular conditions such as stroke, according to findings from a population-based analysis.

Investigators determined the prevalence of migraine and its associated complications during pregnancy in a nationwide inpatient sample from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. They reviewed hospital records for >18.3 million pregnancy-related discharges from 2000 to 2003. Of these hospital records with a pregnancy discharge code, 33,956 also had a code for migraine (185 per 100,000 deliveries).

The data showed significant associations between migraine and stroke (particularly ischemic stroke), myocardial infarction (MI), heart disease, pulmonary embolus, deep venous thrombosis, thrombophilia, and several vascular risk factors, including hypertension, cigarette smoking and diabetes. Migraine was also associated with some--but not all--pregnancy-related complications. For example, migraine was associated with pre-eclampsia, but not gestational diabetes.

By contrast, migraine was not associated with many nonvascular diagnoses, such as pneumonia, transfusions, postpartum infection or hemorrhage, and intrauterine fetal death.

The researchers evaluated the associations between migraine and the various conditions in a multiple logistic regression analysis. In this analysis, which minimized potential confounding by pre-eclampsia, migraine showed a strong association with stroke, venous thromboembolism/pulmonary embolus, MI/heart disease, and hypertension (P<.001 for all).

Specifically, among the women with migraine, the odds ratio (OR) for stroke was 15.05 (95% CI, 8.26-27.4), the odds ratio for venous thromboembolism/pulmonary embolus was 3.23 (95% CI, 2.06-7.07), the odds ratio for acute MI/heart disease was 2.11 (95% CI, 1.76-2.54), and the odds ratio for hypertension was 8.61 (95% CI, 6.43-11.54). Migraine was also associated with pre-eclampsia (OR, 2.29; 95% CI, 2.13-2.46), smoking (OR, 2.85; 95% CI, 2.53-3.21), diabetes (OR, 1.96; 95% CI, 1.64-2.35), and increasing age (OR, 1.03; 95% CI, 1.02-1.03; P<.001 for all).

"Obstetricians, general practitioners, and neurologists should all realize that these results do not apply to every woman with migraine during pregnancy. However, for pregnant women admitted to hospital with active migraines, modifiable cardiovascular risk factors and complications of pregnancy such as pre-eclampsia should be recognized and treated," the authors concluded. (Bushnell CD, et al. BMJ 2009;338:b664.)

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