1. Pre-pregnancy migraine diagnosis, medication use, and spontaneous abortion: a prospective cohort study.
- Author
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Crowe, Holly M., Wesselink, Amelia K., Wise, Lauren A., Jick, Susan S., Rothman, Kenneth J., Mikkelsen, Ellen M., Sørensen, Henrik T., and Hatch, Elizabeth E.
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MIGRAINE prevention , *MIGRAINE diagnosis , *PATIENT aftercare , *CONFIDENCE intervals , *MIGRAINE , *ANALGESICS , *REGRESSION analysis , *SEVERITY of illness index , *QUESTIONNAIRES , *DRUGS , *CAFFEINE , *DRUG utilization , *MEDICAL prescriptions , *PRECONCEPTION care , *REPRODUCTIVE health , *PROPORTIONAL hazards models ,RISK factors in miscarriages - Abstract
Background: Migraine is common among females of reproductive age (estimated prevalence:17–24%) and may be associated with reproductive health through underlying central nervous system excitability, autoimmune conditions, and autonomic dysfunction. We evaluated the extent to which pre-pregnancy migraine diagnosis and medication use are associated with risk of spontaneous abortion (SAB). Methods: We analyzed data from a preconception study of pregnancy planners (2013–2021). Eligible participants self-identified as female, were aged 21–45 years, resided in the USA or Canada, and conceived during follow-up (n = 7890). Participants completed baseline and bimonthly follow-up questionnaires for up to 12 months or until a reported pregnancy, whichever occurred first. Pregnant participants then completed questionnaires during early (~ 8–9 weeks) and late (~ 32 weeks) gestation. We defined migraineurs as participants who reported a migraine diagnosis or use of a medication to treat migraine. Preconception questionnaires elicited migraine medication use during the past 4 weeks, and SAB on follow-up and pregnancy questionnaires. We used Cox regression models with gestational weeks as the time scale to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations among preconception migraine, migraine medication use, and SAB, controlling for potential demographic, medical, and lifestyle confounders. Results: Nineteen percent of study pregnancies ended in SAB. History of migraine before conception was not appreciably associated with SAB risk (HR = 1.03, 95% CI: 0.91–1.06). Use of any migraine medication was associated with a modest increase in SAB risk overall (HR = 1.14, 95% CI: 0.96–1.36). We observed the greatest increase in risk among those taking migraine medications daily (HR = 1.38, 95% CI: 0.81–2.35) and those taking prescription migraine prophylaxis (HR = 1.43, 95% CI: 0.72–2.84) or combination analgesic and caffeine medications (HR = 1.42, 95% CI: 0.99–2.04). Conclusions: Migraine medication use patterns suggesting greater underlying migraine severity were associated with increased risk of SAB. This research adds to the limited information available on the reproductive effects of migraine. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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