妊娠、分娩、新生儿和产后神经结局与偏头痛相关的妊娠。
Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine.
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA.
出版信息
Headache. 2019 Jun;59(6):869-879. doi: 10.1111/head.13536. Epub 2019 May 8.
BACKGROUND
Prevalence of migraine is high during the reproductive age. Although migraine often improves during pregnancy, the risk of adverse pregnancy, birth, neonatal, and neurological outcomes in mother and offspring remains poorly understood.
OBJECTIVE
To investigate the associations between maternal migraine and risks of adverse pregnancy outcomes in the mother, and birth, neonatal and postnatal outcomes in the offspring.
METHODS
We used Danish population registries to assemble a cohort of pregnancies among women with migraine and an age- and conception year-matched comparison cohort of pregnancies among women without migraine. The study period was 2005-2012. We computed adjusted prevalence ratios (aPRs) for pregnancy and birth outcomes and adjusted risk ratios (aRRs) for neonatal and postnatal outcomes, adjusting for age, preconception medical history, and preconception reproductive history.
RESULTS
We identified 22,841 pregnancies among women with migraine and 228,324 matched pregnancies among women without migraine. Migraine was associated with an increased risk of pregnancy-associated hypertension disorders (aPR: 1.50 [95% confidence interval (CI): 1.39-1.61]) and miscarriage (aPR: 1.10 [95% CI: 1.05-1.15]). Migraine was associated with an increased prevalence of low birth weight (aPR: 1.14 [95% CI: 1.06-1.23]), preterm birth (aPR: 1.21 [95% CI: 1.13-1.30]) and cesarean delivery (aPR: 1.20 [95% CI: 1.15-1.25]), but not of small for gestational age offspring (aPR: 0.94 [95% CI: 0.88-0.99]) and birth defects (aPR: 1.01 [95% CI: 0.93-1.09]). Offspring prenatally exposed to maternal migraine had elevated risks of several outcomes in the neonatal and postnatal period, including intensive care unit admission (aRR: 1.22 [95% CI: 1.03-1.45]), hospitalization (aRR: 1.12 [95% CI: 1.06-1.18]), dispensed prescriptions (aRR: 1.34 [95% CI: 1.24-1.45]), respiratory distress syndrome (aRR: 1.20 [95% CI: 1.02-1.42]), and febrile seizures (aRR: 1.27 [95% CI: 1.03-1.57), but not of death (aRR: 0.67 [95% CI: 0.43-1.04]) and cerebral palsy (aRR: 1.00 [95% CI: 0.51-1.94]).
CONCLUSIONS
Women with migraine and their offspring have greater risks of several adverse pregnancy outcomes than women without migraine.
背景
偏头痛在生育年龄的发病率很高。尽管偏头痛在怀孕期间通常会有所改善，但母亲和后代的不良妊娠、分娩、新生儿和神经发育结局的风险仍知之甚少。
目的
调查母亲偏头痛与母亲不良妊娠结局风险以及后代出生、新生儿和产后结局风险之间的关系。
方法
我们使用丹麦人口登记处，为患有偏头痛的女性建立了一个妊娠队列，并为没有偏头痛的女性建立了一个年龄和受孕年份相匹配的对照妊娠队列。研究期间为 2005 年至 2012 年。我们计算了妊娠和分娩结局的调整后患病率比值（aPR）和新生儿和产后结局的调整后风险比（aRR），调整了年龄、孕前病史和孕前生育史。
结果
我们确定了 22841 例患有偏头痛的女性妊娠和 228324 例匹配的无偏头痛女性妊娠。偏头痛与妊娠相关高血压疾病（aPR：1.50[95%置信区间（CI）：1.39-1.61]）和流产（aPR：1.10[95%CI：1.05-1.15]）的风险增加相关。偏头痛与低出生体重（aPR：1.14[95%CI：1.06-1.23]）、早产（aPR：1.21[95%CI：1.13-1.30]）和剖宫产（aPR：1.20[95%CI：1.15-1.25]）的患病率增加有关，但与胎儿大小与胎龄不符（aPR：0.94[95%CI：0.88-0.99]）和出生缺陷（aPR：1.01[95%CI：0.93-1.09]）无关。在产前暴露于母亲偏头痛的后代中，有几种新生儿和产后结局的风险增加，包括入住重症监护病房（aRR：1.22[95%CI：1.03-1.45]）、住院（aRR：1.12[95%CI：1.06-1.18]）、配药（aRR：1.34[95%CI：1.24-1.45]）、呼吸窘迫综合征（aRR：1.20[95%CI：1.02-1.42]）和热性惊厥（aRR：1.27[95%CI：1.03-1.57]），但与死亡（aRR：0.67[95%CI：0.43-1.04]）和脑瘫（aRR：1.00[95%CI：0.51-1.94]）无关。
结论
患有偏头痛的女性及其后代与没有偏头痛的女性相比，有更多的不良妊娠结局风险。
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