Adverse pregnancy outcomes in women with migraine: A retrospective multicenter cohort study
Inbal Akavian, Roie Alter, Hadar Rosen, Itay Nitzan, Ronit Calderon‐Margalit, Doron KabiriAbstract
Objective
Migraine affects 15%–20% of women of reproductive age, with peak incidence during the childbearing years. While prior studies have demonstrated an association between migraine and hypertensive disorders of pregnancy, data on other outcomes and differences between migraine subtypes remain limited. This study aimed to evaluate the relationship between migraine and a comprehensive range of obstetric complications.
Methods
We conducted a historical cohort study using the TriNetX US Collaborative Network, which includes anonymized electronic medical records from 70 US healthcare organizations between 2005 and 2025. Pregnant women aged 18–40 with a prepregnancy migraine diagnosis and no prepregnancy hypertension diagnosis were matched 1:1 to pregnant women without migraine ( n = 176,287 per group) using propensity scores based on age, race and ethnicity, BMI, tobacco or substance use during pregnancy, multiple gestation, thyroid disorders, chronic kidney disease, diabetes mellitus, socioeconomic factors, and psychiatric comorbidities. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for adverse outcome in the migraine group compared with the matched control group.
Results
Women with migraine had significantly higher risks of multiple adverse pregnancy outcomes compared with matched controls. The strongest associations were observed for hypertensive disorders, including eclampsia (OR, 1.69; 95% CI, 1.45–1.96; 0.26% vs. 0.15%), preeclampsia (OR, 1.45; 95% CI, 1.41–1.49; 6.03% vs. 4.25%), and gestational hypertension (OR, 1.47; 95% CI, 1.43–1.51; 8.47% vs. 5.92%), as well as preterm birth (OR, 1.36; 95% CI, 1.31–1.40; 5.80% vs. 4.35%). Elevated risks were also observed for miscarriage, placental abruption, intrauterine fetal demise, and gestational diabetes mellitus. Risks were similar across migraine subtypes (with vs. without aura).
Conclusion
This large, propensity score–matched cohort study demonstrates that migraine independently increases the risk of multiple adverse pregnancy outcomes, with the strongest effects seen in vascular complications such as hypertensive disorders, as well as preterm birth. The consistent pattern of elevated risks across diverse outcomes suggests common underlying mechanisms, likely involving vascular dysfunction and inflammatory pathways. These findings indicate that migraine should be considered an important risk marker in pregnancy.