The Association Between Migraines and Incident Hypertensive Disorders of Pregnancy Among an Obstetric Population at a Large, Urban Safety Net Hospital 公开

Abstract

Introduction: The highest prevalence of migraine attacks typically occurs during a woman’s childbearing years. Migraines in pregnancy are also associated with adverse reproductive outcomes such as pre-term birth, placental abruption, and cesarean section delivery. Evidence shows that pregnancy-associated migraines are associated with hypertensive disorders of pregnancy (HDP) – likely due to shared pathophysiological characteristics. There is limited work examining migraine exposure during pregnancy in relation to HDP subtypes. The goal of this study is to examine if physician-diagnosed, pregnancy-associated migraines are associated with the odds of developing a subtype of hypertensive disorders of pregnancy.

Methods: Data was retrieved from the GOGO database, containing electronic medical records of pregnant patients giving birth at Grady Memorial Hospital between July 1, 2016, and October 31, 2022. We used generalized estimating equations for multinomial logistic regression to examine the associations between physician-diagnosed, pregnancy-associated migraines, covariates of interest and HDP diagnoses at delivery.

Results: Our study sample consisted of 10181 deliveries of which 210 reported a physician-diagnosed, pregnancy-associated migraine. The proportion of deliveries to non-Hispanic Black pregnant patients was higher among those with migraines than those without migraines (82.9% vs 70.2%). Among the 210 migraineurs, 73.0% were multiparous (vs. 67.6%), 11.4% had an anxiety diagnosis (vs. 3.1%), 32.4% were obese (vs. 18.6%), and 24.8% had a pre-existing chronic hypertension diagnosis (vs. 11.4%). After adjusting for confounders, patients with a pregnancy-associated migraine had a 29% marginally increased odds of developing any hypertensive disorder of pregnancy (1.29; 95% CI: 0.97,1.73); 14% increased odds of developing preeclampsia with severe features or eclampsia (1.14; 95% CI: 0.63, 2.06), and 33% increased odds of developing pre-eclampsia without severe features or gestational hypertension (1.33; 95% CI: 0.97,1.81).

Conclusion: In this population with co-occurring chronic conditions, physician-diagnosed, pregnancy-associated migraines were weakly associated with hypertensive disorders of pregnancy. Prospective studies are needed to further evaluate the temporality and extent to which migraines and co-occurring conditions are additionally associated with HDP of differing severity presentation.

Table of Contents

Introduction ...................................................................................................................... 1

Methods ........................................................................................................................... 6

Results ............................................................................................................................ 10

Discussion ....................................................................................................................... 13     

Conclusion……................................................................................................................. 18

References ....................................................................................................................... 20

Figures & Tables ......... ..................................................................................................... 25

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Epidemiology
关键词	hypertensive disorders of pregnancy neurology pre-eclampsia obsterics migraines
Committee Chair / Thesis Advisor	Howards, Penelope P. , Emory University
Committee Members	Boulet, Sheree , Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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