To quantify the associations between self-reported migraine and adverse pregnancy outcomes (APOs).

Migraine affects up to 3 in 10 women of childbearing age and is associated with endothelial dysfunction and inflammation.  Migraine history has previously been associated with APOs, including hypertensive disorders of pregnancy (HDP), preterm delivery, and low birth weight. Few prospective studies have investigated this association in a diverse US cohort.

The Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b) study enrolled 10,038 US participants with singleton gestation in early pregnancy and followed them through delivery. History of migraine was self-reported. We defined APO as 1 or more of the following: gestational hypertension, preeclampsia/eclampsia, preterm delivery, fetal growth restriction, or stillbirth. We calculated odds ratios (OR) and 95% confidence intervals (95%CI) for the association of migraine with APO, adjusting for age, self-reported race/ethnicity, smoking history, chronic hypertension, obesity, chronic kidney disease, pre-gestational diabetes and autoimmune disorders. In secondary analyses, we calculated associations between migraine and individual APOs.

Of the 9169 participants included in the analysis, 1,752 (19.1%) reported migraine at the first study visit. Age and BMI did not differ between migraineurs and non-migraineurs. Migraineurs had higher proportions of self-identified White race, smoking, autoimmune and chronic kidney disease. After adjustment, migraineurs had increased odds of any APO (adjusted OR 1.28, 95% CI 1.13, 1.45). For individual APOs, migraineurs had higher odds of HDP (adjusted OR 1.18, 95% CI 1.05, 1.34) and preterm delivery (adjusted OR 1.41, 95% CI 1.15, 1.72), but not fetal growth restriction or stillbirth.

In this prospective cohort study in a large, diverse US population, migraine was independently associated with increased odds of APO. Migraine is an under-recognized risk factor for APO, especially HDP and preterm delivery, and patients who report migraine history may warrant closer monitoring during pregnancy.