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Cen J, Wang Q, Cheng L, Gao Q, Wang H, Sun F. Global, regional, and national burden and trends of migraine among women of childbearing age from 1990 to 2021: insights from the Global Burden of Disease Study 2021. J Headache Pain 2024; 25:96. [PMID: 38844846 PMCID: PMC11157953 DOI: 10.1186/s10194-024-01798-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Migraine, a neurological disorder with a significant female predilection, is the leading cause of disability-adjusted life years (DALYs) in women of childbearing age (WCBA). There is currently a lack of comprehensive literature analysis on the overall global burden and changing trends of migraines in WCBA. METHODS This study extracted three main indicators, including prevalence, incidence, and DALYs, related to migraine in WCBA from the Global Burden of Disease(GBD) database from 1990 to 2021. Our study presented point estimates with 95% uncertainty intervals (UIs). It evaluated the changing trends in the burden of migraine in WCBA using the estimated annual percentage change (EAPC) and percentage change. RESULTS In 2021, the global prevalence, incidence, and DALYs cases of migraine among WCBA were 493.94 million, 33.33 million, and 18.25 million, respectively, with percentage changes of 48%, 43%, and 47% compared to 1990. Over the past 32 years, global prevalence rates and DALYs rates globally have increased, with an EAPC of 0.03 (95% UI: 0.02 to 0.05) and 0.04 (95% UI: 0.03 to 0.05), while incidence rates have decreased with an EAPC of -0.07 (95% UI: -0.08 to -0.05). Among the 5 Socio-Demographic Index (SDI) regions, in 2021, the middle SDI region recorded the highest cases of prevalence, incidence, and DALYs of migraine among WCBA, estimated at 157.1 million, 10.56 million, and 5.81 million, respectively, approximately one-third of the global total. In terms of age, in 2021, the global incidence cases for the age group 15-19 years were 5942.5 thousand, with an incidence rate per 100,000 population of 1957.02, the highest among all age groups. The total number of migraine cases and incidence rate among WCBA show an increasing trend with age, particularly in the 45-49 age group. CONCLUSIONS Overall, the burden of migraine among WCBA has significantly increased globally over the past 32 years, particularly within the middle SDI and the 45-49 age group. Research findings emphasize the importance of customized interventions aimed at addressing the issue of migraines in WCBA, thus contributing to the attainment of Sustainable Development Goal 3 set by the World Health Organization.
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Affiliation(s)
- Jing Cen
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Qian Wang
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Lin Cheng
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Qian Gao
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongping Wang
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China.
| | - Fengjun Sun
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China.
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Westberg SM, Arellano R, Cieri-Hutcherson NE, Heinrich NT, Herman AM, Lodise NM, McBane S, Ofili TU, O'Grady N, Sankey KH. Pharmacotherapy of Chronic Neuropsychiatric Conditions During Pregnancy. Nurs Womens Health 2024; 28:227-241. [PMID: 38702041 DOI: 10.1016/j.nwh.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/08/2023] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
Many pregnant persons will experience neuropsychiatric conditions during pregnancy, including migraine, attention deficit disorder, depression, and anxiety. Treatment of each of these conditions requires shared decision-making among the individual, family, and health care team. Although medications may include risk, the benefits often outweigh the potential fetal risks. In this article, we review pharmacologic treatment options for each of these conditions and appropriate use in pregnancy to maintain the stability of conditions and to optimize maternal and fetal outcomes.
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Biswas S, Singh R, Radhika AG. Association between migraine and pre-eclampsia among pregnant women: a single hospital-based case-control study in India. BMC Pregnancy Childbirth 2024; 24:373. [PMID: 38755536 PMCID: PMC11100195 DOI: 10.1186/s12884-024-06567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Pre-eclampsia and migraine share some similar aspects of pathophysiology such as vascular function, platelet activation, and enhanced clotting. A few observational studies from different demographics showed that pregnant women with a history of migraine were at higher risk of developing pre-eclampsia. However, there is no such evidence available from the Indian context. Hence, a hospital-based case-control study was conducted among Indian women to determine the association between migraine and pre-eclampsia. METHOD It was a single-centre case-control study in a tertiary care hospital in India. Cases were pregnant women with clinically diagnosed pre-eclampsia, and controls were normotensive pregnant women. Migraine was diagnosed with a questionnaire adapted from the "International Classification of Headache Disorders (ICHD), 3rd Edition" by the International Headache Society, (IHS). We performed logistic regression to explore the association between migraine and pre-eclampsia. RESULT One hundred sixty-four women (82 women per group) were enrolled. The mean age among the cases (24.5 years, standard deviation of 2.4 years) was slightly higher than the mean age of the controls (23.5 years, standard deviation of 2.5 years) with a p-value of 0.006. We found that women with a history of migraine were more likely to develop pre-eclampsia (Adjusted Odds Ratio 6.17; p-value < 0.001, 95% Confidence Interval of 2.85 to 13.62). CONCLUSION The current findings suggest a significant association between migraine and pre-eclampsia aligning with previous study findings; nevertheless, larger follow-up studies including women from different states in India are needed.
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Affiliation(s)
| | | | - A G Radhika
- University College of Medical Science & GTB Hospital, Delhi, India
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Phillips K, Nirantharakumar K, Wakerley BR, Crowe FL. Trends in the prevalence and pharmacological management of migraine during pregnancy in the UK, 2000-2018. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333530. [PMID: 38569874 DOI: 10.1136/jnnp-2024-333530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Migraine is common in women of reproductive age. This study aimed to (1) describe the prevalence of migraine in pregnant women in the UK, (2) identify drugs commonly prescribed for migraine during pregnancy and (3) identify characteristics associated with being prescribed medication for migraine during pregnancy. METHODS The Clinical Practice Research Datalink pregnancy register, a database of pregnancy episodes identified in anonymised primary care health records, was used.Crude and age-standardised prevalence of migraine during pregnancy and the proportion of women with migraine prescribed drugs used for migraine management were calculated for each year between 2000 and 2018.Logistic regression was used to describe the relationship between patient characteristics and being prescribed migraine medication during pregnancy. RESULTS 1 377 053 pregnancies were included, of which 187 328 were in women with a history of migraine. The age-adjusted prevalence increased from 11.4% in 2000 to 17.2% in 2018. There was an increase in the rates of prescription for numerous medications for the management of migraine.Older women (adjusted OR (aOR) 1.41 (1.20 to 1.66)), women of black (aOR 1.40 (1.32 to 1.48)) and South Asian ethnicity (aOR 1.48 (1.38 to 1.59)), those living in the most deprived areas (aOR 1.60 (1.54 to 1.66)), women who were obese (aOR 1.39 (1.35 to 1.43)), smokers (aOR 1.15 (1.12 to 1.18)) and those with comorbid conditions were more likely to receive a prescription during pregnancy. CONCLUSIONS Rates of recorded migraine have increased over the past two decades as well as rates of prescribing in women with migraine. Higher prescribing rates are seen in certain groups, which has the potential to exacerbate health inequalities.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Benjamin R Wakerley
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Phillips K, Clerkin-Oliver C, Nirantharakumar K, Crowe FL, Wakerley BR. How migraine and its associated treatment impact on pregnancy outcomes: Umbrella review with updated systematic review and meta-analysis. Cephalalgia 2024; 44:3331024241229410. [PMID: 38317644 DOI: 10.1177/03331024241229410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Migraine is common in reproductive aged women. Understanding the impact of migraine and associated treatments on pregnancy outcomes remains very important. An umbrella review of systematic reviews, with or without meta-analyses, examined the link between migraine and pregnancy outcomes. METHODS We systematically searched Medline, Embase and Cochrane to 27 October 2022. Quality appraisal was carried out using the AMSTAR2 tool. An established framework was used to determine whether included reviews were eligible for update. RESULTS Four studies met review criteria. Migraine was reported to be associated with increased odds ratio (OR) of pre-eclampsia, low birth weight and peripartum mental illness (pooled OR = 3.54 (2.24-5.59)). Triptan-exposed women had increased odds of miscarriage compared to women without migraine (pooled OR = 3.54 (2.24-5.59)). In updated meta-analyses, migraine was associated with an increased odds of pre-eclampsia and preterm birth (pooled OR = 2.05 (1.47-2.84) and 1.26 (1.21-1.32) respectively). CONCLUSIONS Migraine is associated with increased odds of pre-eclampsia, peripartum mental illness and preterm birth. Further investigation of the relationship between migraine and placental abruption, low birth weight and small for gestational age is warranted, as well as the relationship between migraine, triptans and miscarriage risk.Systematic Review Registration: Prospero CRD42022357630.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Benjamin R Wakerley
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- University Hospital Birmingham, Birmingham, UK
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Fuglsang CH, Pedersen L, Schmidt M, Vandenbroucke JP, Bøtker HE, Sørensen HT. Combined Impact of Migraine and Pregnancy-Induced Hypertension on Long-term Risk of Premature Myocardial Infarction and Stroke. Neurology 2024; 102:e207813. [PMID: 38165376 PMCID: PMC10834138 DOI: 10.1212/wnl.0000000000207813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/10/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Migraine and pregnancy-induced hypertension (PIH) are known to increase cardiovascular risk on their own. However, evidence is limited on the combined impact of migraine and PIH on risk of cardiovascular disease. The aim of this study was to examine the combined impact of migraine and PIH on risk of premature (age 60 years and younger) major adverse cardiovascular and cerebrovascular events (MACCE), a composite end point consisting of myocardial infarction, stroke, or death due to one of these diseases. METHODS We conducted a population-based cohort study in Denmark (1996-2018) among women who had delivered at least one child. This population was stratified into 4 cohorts: women with neither migraine nor PIH, women with migraine, women with PIH, and women with both migraine and PIH. As a measure of absolute risk, we computed the 20-year cumulative incidence of premature MACCE, treating death by other causes than myocardial infarction and stroke as a competing risk. We used Cox regression to compute 20-year adjusted hazard ratios (HRs) of premature MACCE. Women with neither migraine nor PIH served as the comparison cohort. RESULTS The 20-year absolute risk of premature MACCE was 1.3% (95% CI 1.2%; 1.3%) for women without migraine and without PIH (n = 1,288,541), 2.2% (95% CI 2.0%; 2.4%) for women with migraine (n = 54,827), 2.8% (95% CI 2.6%; 3.1%) for women with PIH (n = 49,008), and 3.1% (95% CI 2.1%; 4.4%) for women with both migraine and PIH (n = 3,140). The adjusted HR of premature MACCE was 1.66 (95% confidence interval [CI] 1.50-1.84) for women with migraine, 2.76 (95% CI 2.52-3.03) for women with PIH, and 2.41 (95% CI 1.61-3.61) for women with both migraine and PIH. DISCUSSION Migraine and PIH separately increased the risk of premature MACCE. The risk of premature MACCE among women who had both migraine and PIH was similar to that among women with PIH only.
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Affiliation(s)
- Cecilia Hvitfeldt Fuglsang
- From the Department of Clinical Epidemiology (C.H.F., L.P., M.S., H.T.S.), Aarhus University Hospital; Department of Clinical Medicine (C.H.F., L.P., M.S., J.V., H.T.S.), Aarhus University; Department of Cardiology (M.S.), Aarhus University Hospital, Denmark; Leiden University Medical Center (J.V.), Leiden, The Netherlands; London School of Hygiene and Tropical Medicine (J.V.), University of London; Faculty of Health (H.E.B.), Aarhus University; and Department of Cardiology (H.E.B.), Aarhus University Hospital, Denmark
| | - Lars Pedersen
- From the Department of Clinical Epidemiology (C.H.F., L.P., M.S., H.T.S.), Aarhus University Hospital; Department of Clinical Medicine (C.H.F., L.P., M.S., J.V., H.T.S.), Aarhus University; Department of Cardiology (M.S.), Aarhus University Hospital, Denmark; Leiden University Medical Center (J.V.), Leiden, The Netherlands; London School of Hygiene and Tropical Medicine (J.V.), University of London; Faculty of Health (H.E.B.), Aarhus University; and Department of Cardiology (H.E.B.), Aarhus University Hospital, Denmark
| | - Morten Schmidt
- From the Department of Clinical Epidemiology (C.H.F., L.P., M.S., H.T.S.), Aarhus University Hospital; Department of Clinical Medicine (C.H.F., L.P., M.S., J.V., H.T.S.), Aarhus University; Department of Cardiology (M.S.), Aarhus University Hospital, Denmark; Leiden University Medical Center (J.V.), Leiden, The Netherlands; London School of Hygiene and Tropical Medicine (J.V.), University of London; Faculty of Health (H.E.B.), Aarhus University; and Department of Cardiology (H.E.B.), Aarhus University Hospital, Denmark
| | - Jan P Vandenbroucke
- From the Department of Clinical Epidemiology (C.H.F., L.P., M.S., H.T.S.), Aarhus University Hospital; Department of Clinical Medicine (C.H.F., L.P., M.S., J.V., H.T.S.), Aarhus University; Department of Cardiology (M.S.), Aarhus University Hospital, Denmark; Leiden University Medical Center (J.V.), Leiden, The Netherlands; London School of Hygiene and Tropical Medicine (J.V.), University of London; Faculty of Health (H.E.B.), Aarhus University; and Department of Cardiology (H.E.B.), Aarhus University Hospital, Denmark
| | - Hans Erik Bøtker
- From the Department of Clinical Epidemiology (C.H.F., L.P., M.S., H.T.S.), Aarhus University Hospital; Department of Clinical Medicine (C.H.F., L.P., M.S., J.V., H.T.S.), Aarhus University; Department of Cardiology (M.S.), Aarhus University Hospital, Denmark; Leiden University Medical Center (J.V.), Leiden, The Netherlands; London School of Hygiene and Tropical Medicine (J.V.), University of London; Faculty of Health (H.E.B.), Aarhus University; and Department of Cardiology (H.E.B.), Aarhus University Hospital, Denmark
| | - Henrik Toft Sørensen
- From the Department of Clinical Epidemiology (C.H.F., L.P., M.S., H.T.S.), Aarhus University Hospital; Department of Clinical Medicine (C.H.F., L.P., M.S., J.V., H.T.S.), Aarhus University; Department of Cardiology (M.S.), Aarhus University Hospital, Denmark; Leiden University Medical Center (J.V.), Leiden, The Netherlands; London School of Hygiene and Tropical Medicine (J.V.), University of London; Faculty of Health (H.E.B.), Aarhus University; and Department of Cardiology (H.E.B.), Aarhus University Hospital, Denmark
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Adam I, Elmugabil A, AlHabardi N. History of maternal migraine and its association with preeclampsia: A case-control study in a low-resource setting in Sudan, Africa. Cephalalgia 2023; 43:3000605231193823. [PMID: 37622427 DOI: 10.1177/03331024231196303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND Previous studies have reported various levels of association between migraine and preeclampsia. However, there are no published data on migraine and its association with preeclampsia in African countries, including Sudan. METHODS A case-control study was conducted at Rabak Maternity Hospital in White Nile State, Central Sudan. The cases were pregnant women with preeclampsia, while the controls were healthy pregnant women. All participants were interviewed using questionnaire. The adjusted odds ratio (AOR) and a 95% confidence interval (CI) were calculated in a multivariate regression analysis. RESULTS Of 148 pregnant women with preeclampsia, 96 (64.9%) women had mild preeclampsia and 52 (35.1%) women had severe preeclampsia. Of the 148 study participants with preeclampsia, 57 (38.5%) had a history of migraine and 19/296 (6.4%) women in control group had a history of migraine (p < 0.001). Pregnant women with a history of migraine have higher odds of preeclampsia than pregnant women without a history of migraine (AOR = 9.01, 95% CI = 4.81-16.86). A history of preeclampsia, being overweight and obesity were associated with preeclampsia. CONCLUSION Our findings are consistent with the findings of previous studies on the association between migraine and preeclampsia. More studies are needed on this topic.
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Affiliation(s)
- Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | | | - Nadiah AlHabardi
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
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Kardes G, Hadimli A, Ergenoglu AM. Determination of the Frequency of Migraine Attacks in Pregnant Women and the Ways They Cope with Headaches: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2070. [PMID: 37510512 PMCID: PMC10379615 DOI: 10.3390/healthcare11142070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
One out of every five women of reproductive age suffers from migraine. Although headaches subside in most women during pregnancy, attacks continue and even worsen in some women. Pregnant women try to relieve pain with medication or non-pharmacological treatment methods. This descriptive and cross-sectional study was conducted to determine the incidence of migraine attacks in pregnant women diagnosed with migraine and the ways they cope with headaches. The study included 191 pregnant women who were diagnosed with migraine in the pre-pregnancy period. McNemar analysis was performed to test the relationship between descriptive statistical methods and categorical variables when the data were analyzed. The mean gestational age of the participants was 28.31 ± 8.64 weeks, and their mean age at the onset of migraine was 20.74 ± 5.63 years. The comparison of the duration, frequency, and severity of headaches suffered before and during pregnancy demonstrated that there were statistical differences between them (p < 0.05). The frequency of using methods such as taking painkillers, resting in a dark room, and having cold application and massage to relieve headaches before pregnancy decreased statistically significantly during pregnancy (p < 0.05). As a result, the frequency and severity of migraines decrease during pregnancy. The tendency to resort to pharmacological or non-pharmacological methods used to relieve headaches decreases during pregnancy. Although migraine has many adverse effects on pregnancy, pregnant women do not demand satisfactory information from health professionals about migraine headaches during pregnancy.
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Affiliation(s)
- Guzin Kardes
- Faculty of Health Science, Ege University, Izmir 35575, Turkey
| | - Aytul Hadimli
- Faculty of Health Science, Ege University, Izmir 35575, Turkey
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Crowe HM, Wesselink AK, Hatch EE, Wise LA, Jick SS. Migraine and risk of hypertensive disorders of pregnancy: A population-based cohort study. Cephalalgia 2023; 43:3331024231161746. [PMID: 36935588 PMCID: PMC11000583 DOI: 10.1177/03331024231161746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Migraine is associated with hypertensive disorders of pregnancy through common pathophysiological features. This study evaluates the association between migraine diagnosis and treatment, and risk of hypertensive disorders of pregnancy. METHODS We conducted a prospective cohort study in the Clinical Practice Research Datalink GOLD, a large longitudinal database of patient records in the UK. We analyzed data from liveborn or stillborn singleton deliveries from 1993-2020 with at least 24 months of medical history and no history of cardiovascular disease (n = 1,049,839). We ascertained migraine through diagnosis or prescription codes before 20 weeks of gestation and hypertensive disorders of pregnancy through diagnosis codes between 20 weeks of pregnancy and delivery. We used log-binomial regression models to estimate the risk ratio and 95% confidence intervals, comparing risk of hypertensive disorders of pregnancy among individuals with migraine to those without migraine, adjusting for confounders. CONCLUSIONS A history of migraine prior to pregnancy was associated with an increased risk of hypertensive disorders of pregnancy (RR = 1.17, 95% CI: 1.09-1.26). The greatest risk was among those with pre-pregnancy migraine that persisted into the first trimester (RR = 1.84, 95% CI: 1.35-2.50). Use of migraine medication was associated with a higher risk of hypertensive disorders of pregnancy compared to non-migraineurs (RR = 1.50, 95% CI: 1.15-1.97). Results from this study indicate that migraine is a potential risk factor for hypertensive disorders of pregnancy.
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Affiliation(s)
- Holly M Crowe
- Department of Epidemiology, Harvard TH Chan School of Public Health, MA, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, MA, USA
| | - Susan S Jick
- Department of Epidemiology, Boston University School of Public Health, MA, USA
- Boston Collaborative Drug Surveillance Program, MA, USA
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Noseda R, Bedussi F, Gobbi C, Ceschi A, Zecca C. Safety profile of monoclonal antibodies targeting the calcitonin gene-related peptide system in pregnancy: Updated analysis in VigiBase®. Cephalalgia 2023; 43:3331024231158083. [PMID: 36855950 DOI: 10.1177/03331024231158083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Safety data on the use of migraine preventive monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) system in pregnancy are limited. METHODS Updated pharmacovigilance assessment of the safety reports related to pregnancy associated with erenumab, galcanezumab, fremanezumab and eptinezumab, retrieved from VigiBase® as of 31 December 2021. As primary outcome, the whole group of monoclonal antibodies targeting the CGRP system was considered and sex and age subgroup disproportionality analyses using the reporting odds ratio (ROR) were conducted. RESULTS 286 safety reports were found: 116 (40.6%) on erenumab, 125 (43.7%) on galcanezumab, 39 (13.6%) on fremanezumab, 6 (2.1%) on eptinezumab. One hundred and forty-nine (52.1%) safety reports reported only drug exposure in relation to pregnancy while 137 (47.9%) also included ≥1 pregnancy outcomes: maternal outcomes (n = 64), spontaneous abortion (n = 63), foetal growth restriction (n = 1), prematurity (n = 8), neonatal outcomes (n = 13), and poor breastfeeding (n = 1). No specific patterns of maternal, foetal and neonatal toxicity were observed. Spontaneous abortion was not disproportionally more frequently reported with erenumab, galcanezumab, fremanezumab and eptinezumab compared with the entire database (ROR 1.1, 95% confidence interval, CI, 0.8-1.5), the entire database since 2018 (ROR 1.3, 95% CI 1.0-1.8), and triptans (ROR 1.2, 95% CI 0.8-1.9). CONCLUSIONS This updated safety analysis on erenumab, galcanezumab, fremanezumab and eptinezumab in pregnancy showed no signals of foeto-maternal toxicity according to VigiBase® safety reports.
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Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Bedussi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - Chiara Zecca
- Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Miller EC, Chau K, Mammadli G, Levine LD, Grobman WA, Wapner R, Bello NA. Migraine and adverse pregnancy outcomes: the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be. Am J Obstet Gynecol 2022; 227:535-536. [PMID: 35504328 PMCID: PMC9926481 DOI: 10.1016/j.ajog.2022.04.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Eliza C Miller
- Department of Neurology, Columbia University, New York, NY; The Neurological Institute of New York, Columbia University Irving Medical Center, 710 West 168th St., New York, NY 10033.
| | - Kristi Chau
- Department of Neurology, Columbia University, New York, NY
| | - Gular Mammadli
- Department of Neurology, Columbia University, New York, NY
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Natalie A Bello
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Abstract
PURPOSE To provide updated evidence-based recommendations for the evaluation and treatment of primary and secondary headaches in pregnancy and postpartum. TARGET POPULATION Pregnant and postpartum patients with a history of or experiencing primary or new secondary headaches. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on interventions to prevent primary headache in individuals who are pregnant or attempting to become pregnant, postpartum, or breastfeeding; evaluation for symptomatic patients presenting with primary and secondary headaches during pregnancy; and treatment options for primary and secondary headaches during pregnancy and lactation. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Bączkowska M, Kosińska-Kaczyńska K, Zgliczyńska M, Brawura-Biskupski-Samaha R, Rebizant B, Ciebiera M. Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption-Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5148. [PMID: 35564543 PMCID: PMC9101673 DOI: 10.3390/ijerph19095148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 12/10/2022]
Abstract
Placental abruption (PA) is a separation of the placenta from the uterine wall occurring with the fetus still present in the uterine cavity. It contributes to numerous neonatal and maternal complications, increasing morbidity and mortality. We conducted a retrospective study at a tertiary perinatal care center, which included 2210 cases of labor that took place in 2015 with a PA occurrence of 0.7%. No maternal or fetal death during delivery was reported in this period. The identified PA risk factors were uterine malformations, pPROM, placenta previa spectrum, and oligohydramnios. The significant maternal PA complications identified were maternal anemia, uterine rupture, and HELLP syndrome. Preterm delivery occurred significantly more often in the PA group, and the number of weeks of pregnancy and the birth weight at delivery were both significantly lower in the PA group. PA is a relatively rare perinatal complication with very serious consequences, and it still lacks effective prophylaxis and treatment. Despite its rare occurrence, each center should develop a certain strategy for dealing with this pathology or predicting which patients are at risk. Much work is still needed to ensure the proper care of the mother and the baby in this life-threatening condition.
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Affiliation(s)
| | | | | | | | | | - Michał Ciebiera
- Center of Postgraduate Medical Education, Second Department of Obstetrics and Gynecology, 01-813 Warsaw, Poland; (M.B.); (K.K.-K.); (M.Z.); (R.B.-B.-S.); (B.R.)
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14
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Decker BM, Thibault D, Davis KA, Willis AW. Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis. Neurology 2022; 98:e1545-e1554. [PMID: 35169012 PMCID: PMC9012272 DOI: 10.1212/wnl.0000000000200007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare maternal obstetric complications and nonelective readmissions in women with common neurologic comorbidities (WWN) vs women without neurologic disorders. METHODS We performed a retrospective cohort study of index characteristics and acute postpartum, nonelective rehospitalizations from the 2015-2017 National Readmissions Database using ICD-10 codes. Wald χ2 testing compared baseline demographic, hospital, and clinical characteristics and postpartum complications between WWN (including previous stroke, migraine, multiple sclerosis [MS], and myasthenia gravis [MG]) and controls. Multivariable logistic regression models examined odds of postpartum complications and nonelective readmissions within 30 and 90 days for each neurologic comorbidity compared to controls (α = 0.05). RESULTS A total of 7,612 women with previous stroke, 83,430 women with migraine, 6,760 women with MS, 843 women with MG, and 8,136,335 controls met the criteria for index admission after viable infant delivery. WWN were more likely than controls to have inpatient diagnoses of edema, proteinuria, or hypertensive disorders and to have received maternal care for poor fetal growth. The adjusted odds of a Centers for Disease Control and Prevention severe maternal morbidity indicator were greater for women with previous stroke (adjusted odds ratio [AOR] 8.53, 95% CI 7.24-10.06), migraine (AOR 2.04, 95% CI 1.85-2.26), and MG (AOR 4.45, 95% CI 2.45-8.08) (all p < 0.0001). Readmission rates at 30 and 90 days for WWN were higher than for controls (30 days: previous stroke 2.9%, migraine 1.7%, MS 1.8%, MG 4.3%, controls 1.1%; 90 days: previous stroke 3.7%, migraine 2.5%, MS 5.1%, MG 6.0%, controls 1.6%). Women with MG had the highest adjusted odds of readmission (30 days: AOR 3.96, 95% CI 2.37-6.65, p < 0.0001; 90 days: AOR 3.30, 95% CI 1.88-5.78, p < 0.0001). DISCUSSION WWN may be at higher risk of severe maternal morbidity at the time of index delivery and postpartum readmission. More real-world evidence is needed to develop research infrastructure and create efficacious interventions to optimize maternal-fetal outcomes in WWN, especially for women with previous stroke or MG.
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Affiliation(s)
- Barbara M Decker
- From the Department of Neurology (B.M.D., K.A.D., A.W.W.), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (B.M.D., D.T., A.W.W.), Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, School of Medicine (B.M.D., D.T., A.W.W.), and Leonard Davis Institute of Health Economics (B.M.D., A.W.W.), University of Pennsylvania, Philadelphia; and Department of Neurological Sciences (B.M.D.), University of Vermont Medical Center, Burlington
| | - Dylan Thibault
- From the Department of Neurology (B.M.D., K.A.D., A.W.W.), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (B.M.D., D.T., A.W.W.), Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, School of Medicine (B.M.D., D.T., A.W.W.), and Leonard Davis Institute of Health Economics (B.M.D., A.W.W.), University of Pennsylvania, Philadelphia; and Department of Neurological Sciences (B.M.D.), University of Vermont Medical Center, Burlington
| | - Kathryn A Davis
- From the Department of Neurology (B.M.D., K.A.D., A.W.W.), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (B.M.D., D.T., A.W.W.), Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, School of Medicine (B.M.D., D.T., A.W.W.), and Leonard Davis Institute of Health Economics (B.M.D., A.W.W.), University of Pennsylvania, Philadelphia; and Department of Neurological Sciences (B.M.D.), University of Vermont Medical Center, Burlington
| | - Allison W Willis
- From the Department of Neurology (B.M.D., K.A.D., A.W.W.), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (B.M.D., D.T., A.W.W.), Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, School of Medicine (B.M.D., D.T., A.W.W.), and Leonard Davis Institute of Health Economics (B.M.D., A.W.W.), University of Pennsylvania, Philadelphia; and Department of Neurological Sciences (B.M.D.), University of Vermont Medical Center, Burlington
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15
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Garovic VD, Dechend R, Easterling T, Karumanchi SA, McMurtry Baird S, Magee LA, Rana S, Vermunt JV, August P. Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e21-e41. [PMID: 34905954 PMCID: PMC9031058 DOI: 10.1161/hyp.0000000000000208] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.
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16
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Chen W, Qian W, Zhong L, Jing G. Migraine and Medical Ramifications: A Comprehensive Overview Based on Observational Study Meta-Analyses. Front Neurol 2022; 12:778062. [PMID: 35002929 PMCID: PMC8739214 DOI: 10.3389/fneur.2021.778062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: An umbrella review was conducted for comprehensively evaluating previous review-based literature together with meta-analysis of observational investigations probing correlations between migraine and medical end-point ramifications in patients. The breadth and validity of these associations were assessed. Methods: Multiple online scientific repositories (including PubMed, Medline, Embase, and Web of Science) were investigated (inception-August 2021) for related meta-analyses focusing on links between migraine and all possible health/medical ramification end-points. A summary effect size and 95% CIs were determined for each identified study with such links. Heterogeneity and small-study influence traces were also evaluated. The AMSTAR 2 platform was employed for evaluating standards of methodology, together with objective criteria, for assessing the standards of datasets from each medical end-point scrutinized in this study. Results: A total of 25 scientific reports comprising 10,237,230 participants for 49 meta-analyses of observational studies were selected. Among such 49 outcomes, 30 demonstrated statistical significance (P < 0.05). Significant associations were observed in multiple diseases, including cardiovascular/cerebrovascular, cerebral, pregnancy-related and metabolic disorders, other outcomes, and mortality. Conclusion: The results showed that migraine increased the risk of 29 health outcomes, though lowered the risk of breast cancer. However, evidence quality was graded as high only for angina. The evidence quality of ischaemic stroke, stroke, MACCE, WMAs, and asthma was graded as moderate. All remaining 24 outcomes had an evidence grade of “weak.”
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Affiliation(s)
- Weiwei Chen
- Department of Gastroenterology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Wenqi Qian
- Department of Pharmacy, People's Hospital of Qiandongnan and Dong Autonomous Prefecture, Kaili, China
| | - Lixian Zhong
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Gongwei Jing
- Department of Nuclear Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
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17
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Bérard A, Strom S, Zhao JP, Kori S, Albrecht D. Dihydroergotamine and triptan use to treat migraine during pregnancy and the risk of adverse pregnancy outcomes. Sci Rep 2021; 11:19302. [PMID: 34588467 PMCID: PMC8481540 DOI: 10.1038/s41598-021-97092-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Migraine is prevalent during pregnancy. Antimigraine medications such as dihydroergotamine (DHE) and triptans have been associated with adverse pregnancy outcomes in individual studies but lack of consensus remains. We compared the risk of prematurity, low birth weight (LBW), major congenital malformations (MCM), and spontaneous abortions (SA) associated with gestational use of DHE or triptans. Three cohort and one nested-case–control analyses were conducted within the Quebec Pregnancy Cohort to assess the risk of prematurity, LBW, MCM, and SA. Exposure was defined dichotomously as use of DHE or triptan during pregnancy. Generalized estimation equations were built to quantify the associations, adjusting for potential confounders. 233,900 eligible pregnancies were included in the analyses on prematurity, LBW, and MCM; 29,104 cases of SA were identified. Seventy-eight subjects (0.03%) were exposed to DHE and 526 (0.22%) to triptans. Adjusting for potential confounders, DHE and triptans were associated with increased risks of prematurity, LBW, MCM, and SA but not all estimates were statistically significant. DHE was associated with the risk of prematurity (aRR: 4.12, 95% CI 1.21–13.99); triptans were associated with the risk of SA (aOR: 1.63, 95% CI 1.34–1.98). After considering maternal migraine, all antimigraine specific medications increased the risk of some adverse pregnancy outcomes, but estimates were unstable.
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Affiliation(s)
- Anick Bérard
- Faculty of Pharmacy, University of Montreal, Montreal, QC, H3T 1J4, Canada. .,Research Center, CHU Sainte-Justine, Montreal, QC, H3T 1C5, Canada. .,Faculty of Medicine, Université Claude Bernard, Lyon 1, 69622, Lyon, France.
| | - Shannon Strom
- Satsuma Pharmaceuticals, Inc, San Francisco, CA, 94080, USA
| | - Jin-Ping Zhao
- Research Center, CHU Sainte-Justine, Montreal, QC, H3T 1C5, Canada
| | - Shashi Kori
- Satsuma Pharmaceuticals, Inc, San Francisco, CA, 94080, USA
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18
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Henderson JT, Vesco KK, Senger CA, Thomas RG, Redmond N. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 326:1192-1206. [PMID: 34581730 DOI: 10.1001/jama.2021.8551] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Preeclampsia is a hypertensive disorder of pregnancy that poses serious maternal and infant health risks. Previous systematic reviews have established benefits of low-dose aspirin taken during pregnancy to prevent preeclampsia and its sequelae. OBJECTIVE To update evidence for the US Preventive Services Task Force (USPSTF) on effectiveness of aspirin use in preventing preeclampsia in individuals at increased risk based on clinical risk factors or measurements associated with higher disease incidence than in the general population. DATA SOURCES Studies from previous USPSTF review (2014), literature published January 2013 through May 15, 2020, in MEDLINE, PubMed (for publisher-supplied records only), EMBASE, and Cochrane Central Register of Controlled Trials. Ongoing surveillance through January 22, 2021. STUDY SELECTION Good- and fair-quality randomized clinical trials (RCTs) of low-dose aspirin use during pregnancy to prevent preeclampsia among individuals at increased risk; studies conducted in general populations to evaluate potential harms. DATA EXTRACTION AND SYNTHESIS Dual article screening and risk-of-bias assessment. Study data abstracted into prespecified forms, checked for accuracy. Random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Diagnosis of preeclampsia; adverse pregnancy health outcomes and complications including eclampsia, perinatal mortality, preterm birth, small for gestational age, and potential bleeding harms or infant/child harms from aspirin exposure. RESULTS A total of 23 randomized clinical trials (RCTs) (N = 26 952) were included; 18 were conducted among participants at increased preeclampsia risk. Aspirin dosages ranged from 50 mg/d to 150 mg/d. Most trials enrolled majority White populations selected based on a range of risk factors. The incidence of preeclampsia among the trials of participants at increased risk ranged from 4% to 30%. Aspirin use was significantly associated with lower risk of preeclampsia (pooled relative risk [RR], 0.85 [95% CI, 0.75-0.95]; 16 RCTs [n = 14 093]; I2 = 0%), perinatal mortality (pooled RR, 0.79 [95% CI, 0.66-0.96]; 11 RCTs [n = 13 860]; I2 = 0%), preterm birth (pooled RR, 0.80 [95% CI, 0.67-0.95]; 13 RCTs [n = 13 619]; I2 = 49%), and intrauterine growth restriction (pooled RR, 0.82 [95% CI, 0.68-0.99]; 16 RCTs [n = 14 385]; I2 = 41%). There were no significant associations of aspirin use with risk of postpartum hemorrhage (pooled RR, 1.03 [95% CI, 0.94-1.12]; 9 RCTs [n = 23 133]; I2 = 0%) and other bleeding-related harms, or with rare perinatal or longer-term harms. Absolute risk reductions for preeclampsia associated with aspirin use ranged from -1% to -6% across larger trials (n >300) and were greater in smaller trials. For perinatal mortality, absolute risk reductions ranged from 0.5% to 1.1% in the 3 largest trials. CONCLUSIONS AND RELEVANCE Daily low-dose aspirin during pregnancy was associated with lower risks of serious perinatal outcomes for individuals at increased risk for preeclampsia, without evident harms.
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Affiliation(s)
- Jillian T Henderson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Kimberly K Vesco
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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19
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Ducros A, de Gaalon S, Roos C, Donnet A, Giraud P, Guégan-Massardier E, Lantéri-Minet M, Lucas C, Mawet J, Moisset X, Valade D, Demarquay G. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 2: Pharmacological treatment. Rev Neurol (Paris) 2021; 177:734-752. [PMID: 34340810 DOI: 10.1016/j.neurol.2021.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022]
Abstract
The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the second part of the guidelines, which is focused on the pharmacological treatment of migraine, including both the acute treatment of attacks and the prophylaxis of episodic migraine as well as chronic migraine with and without medication overuse. The specific situations that can be encountered in women with migraine are also discussed, including pregnancy, menstrual migraine, contraception and hormonal replacement therapy.
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Affiliation(s)
- A Ducros
- Department of neurology, Gui-de-Chauliac hospital, CHU Montpellier, university of Montpellier, 34000 Montpellier, France
| | - S de Gaalon
- Department of neurology, Laënnec hospital, CHU de Nantes, Nantes, France
| | - C Roos
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Donnet
- Centre d'évaluation et de traitement de la douleur, FHU INOVPAIN, hôpital de La Timone, Marseille, France
| | - P Giraud
- Department of neurology, Annecy Genevois hospital, Annecy, France
| | | | - M Lantéri-Minet
- Pain department, FHU InovPain, CHU Nice Côte Azur université, Nice, France
| | - C Lucas
- Centre d'évaluation et de traitement de la douleur, service de neurochirurgie, hôpital Salengro, CHRU de Lille, Lille, France
| | - J Mawet
- Emergency headache center (centre d'urgences céphalées), department of neurology, Lariboisière hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - X Moisset
- Neuro-Dol, université Clermont Auvergne, CHU de Clermont-Ferrand, INSERM, Clermont-Ferrand, France
| | - D Valade
- Department of neurosurgery, hôpital Pitié-Sapêtrière, Paris, France
| | - G Demarquay
- Neurological hospital, Lyon, neuroscience research center (CRNL), INSERM U1028, CNRS UMR5292, Lyon, France.
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Abstract
PURPOSE OF REVIEW Women are greatly overrepresented among patients seeking treatment for symptoms of headache pain in general and migraine in particular. Understanding the presentation of headache in women in relation to hormonal changes both during the menstrual cycle and throughout the life span is essential for appropriate diagnosis and treatment. RECENT FINDINGS Although perimenstrual migraine attacks are generally without aura, the diagnosis of migraine with aura has been added to the headache classification for menstrual migraine to account for women with the diagnosis of migraine with aura who experience menstrual migraine attacks. Emerging knowledge regarding the differences between menstrual and nonmenstrual attacks, the variability of attack triggering within and between women, and the response of women with menstrually related migraine to new migraine drug classes is contributing to better understanding and more effective treatment of these particularly burdensome and refractory attacks. Given the burden of migraine, almost one-fourth of women with migraine avoid or delay pregnancy. Women who experience migraine during pregnancy are more likely to have a hypertensive disorder and stroke during pregnancy and/or delivery and the postpartum period. Treatment of headache in general and migraine in particular in pregnancy is challenging because of fetal and maternal risks; however, a 2021 systematic review suggests that triptans and low-dose aspirin may not be associated with fetal/child adverse effects and could be more strongly considered for headache treatment in pregnancy. SUMMARY Headache in general and migraine in particular are extraordinarily common in women of reproductive age and fluctuate with hormonal changes and phases of life. Improved knowledge of the epidemiology, pathophysiology, and response to treatment of perimenstrual attacks is essential for more effective response to this most burdensome headache type. Treatment of headache in pregnancy remains challenging.
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21
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Paškevičiūtė E, Bužinskienė D, Ryliškienė K. De novo Migraine with Aura in the Third Trimester of Pregnancy: A Case Report and Literature review. Acta Med Litu 2021; 28:145-152. [PMID: 34393637 PMCID: PMC8311834 DOI: 10.15388/amed.2021.28.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Among all headache disorders, migraine has the highest prevalence during gestation. The majority of migraineurs experience improvement during pregnancy, but a few may experience migraine for the first time. This poses a diagnostic challenge in the differential diagnosis between primary and life-threatening secondary headache disorders. Because pregnancy itself is an independent risk factor for secondary headache disorders, it is mandatory to exclude these conditions in order to diagnose migraine. There is a large body of literature about pre-existing migraine course during pregnancy and its link with adverse pregnancy outcomes, but there are no studies examining these aspects among women with new-onset migraine during pregnancy. Case report A 31-year-old female at 33 weeks of gestation (gravida 2, para 2) was referred to the neurologist eds disturbances, which were followed by pressing severe headache, rated as 8 out of 10 on a numeric rating scale and accompanied by dizziness. The headache lasted for one day, and dizziness continued to the following day. The patient was investigated for a secondary headache disorder, but laboratory and neuroimaging results were unremarkable. A migraine with aura was diagnosed. The patient was advised to keep a consistent sleep schedule, maintain regular low physical activity, eat regularly and take magnesium supplementation. The patient was informed about a safe treatment approach in case of an acute attack. At 40 weeks of gestation the patient delivered female newborn, weighing 3750g, with Apgar scores of 8 and 9 (due to a nuchal cord). The postpartum period was uneventful. During the subsequent 4 years, the patient did not experience any recurrent migraine attacks and had no pregnancies. Conclusion In order to diagnose a migraine during pregnancy, exclusion of secondary headache disorders is mandatory. Pregnant migraineur should be regularly monitored for adverse birth outcomes. It is essential to educate patients, provide information about the safe treatment of migraine attacks, and explain nonpharmacological prevention and supplementation benefits.
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Affiliation(s)
- Elena Paškevičiūtė
- ORCID: https://orcid.org/0000-0002-1847-5640Vilnius University, Faculty of Medicine, Vilnius, Lithuania
| | - Diana Bužinskienė
- ORCID: https://orcid.org/0000-0002-4522-0600Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, LithuaniaCentre of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kristina Ryliškienė
- ORCID: https://orcid.org/0000-0001-9596-1733Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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22
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A systematic review and meta-analyses on the prevalence of pregnancy outcomes in migraine treated patients: a contribution from the IMI2 ConcePTION project. J Neurol 2021; 269:742-749. [PMID: 33792783 DOI: 10.1007/s00415-021-10534-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022]
Abstract
The present study aims to summarize the safety profile of the medications used to treat migraine during pregnancy by performing a systematic review and meta-analyses. The term "migrain*" combined with pregnancy terms were used to search Embase, PubMed, PsychInfo, Scopus, and Web of Science through 31 December 2020. Pooled prevalences of untreated and treated migraine patients were estimated using MetaXL software. Pooled odds ratios (OR) using random effects models were estimated in RevMan 5. All the identified studies assessed medications used to treat acute migraine. The pooled prevalence of adverse pregnancy outcomes in patients prescribed any migraine medication ranged from 0.4% (95% CI 0.2-0.7%) for stillbirth to 12.0% (95%CI 7.8-16.9%) for spontaneous abortions. Among untreated patients with migraine, the pooled prevalence of the assessed pregnancy outcomes ranged from 0.6% (95% CI: 0-1.7%) for stillbirth to 10.4% (95% CI: 8.9-12%) for gestational age < 37 weeks. Given the limited data, it was only possible to perform OR meta-analyses for triptans. The adjusted ORs for triptan users compared the general population were: for major malformations 1.07 (95%CI: 0.83-1.39, p = 0.60); birth weight < 2500g 1.18 (95%CI: 0.94-1.48, p = 0.16); gestational age < 37 weeks 1.49 (95% CI: 0.37-6.08, p = 0.58). In conclusion, triptans do not appear to increase the risk of pregnancy outcomes when compared to the general population. It was not possible to assess other migraine medications. Further studies are needed to investigate the safety of individual medications of acute and prophylactic migraine treatment among pregnant women.
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Bovbjerg ML, Misra D, Snowden JM. Current Resources for Evidence-Based Practice, November 2020. J Obstet Gynecol Neonatal Nurs 2020; 49:605-619. [PMID: 33096044 PMCID: PMC7575432 DOI: 10.1016/j.jogn.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of diversity in the maternity care workforce and commentaries on reviews focused on burnout in midwifery and a cross-national comparison of guidelines for uncomplicated childbirth.
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