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

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.