Abstract WP232: The Association Between Migraine and Postpartum Adverse Vascular Events

Abstract

Background: We evaluate the association of migraine before and during pregnancy with the development of major adverse vascular events (MAVE) during an extended postpartum period of 24 weeks. Methods: We identified pregnant women aged between 12 and 44 years from the state inpatient databases of New York, Florida, Georgia, Maryland, and Washington (2016 - 2019). Patients were followed up for up to 24 weeks postpartum. Patients with migraine (ICD-10 code: G43) before or during pregnancy were considered to have a history of migraine. We fit multivariable logistic regression models to evaluate the association between the history of migraine and the development of MAVE (stroke, acute coronary syndrome, systemic thromboembolism, hypertensive encephalopathy, pulmonary heart disease, or death) up to 24 weeks after delivery. Patients with a history of MAVE before or during pregnancy were excluded. Adjusted odds ratios (aOR) and 95% confidence interval (CI) are reported. Results: Among 1,568,646 eligible participants (mean age [SD]: 29 [5.7] years), 43,840 (2.79%) had a documented history of migraine. Women with a history of migraine (vs. those without a history of migraine) had higher odds of experiencing MAVE (268/43840 [0.61%] vs. 4556/1524806 [0.3%], aOR, 95% CI: 1.47, 1.30 - 1.67). Also, older age (aOR, CI: 1.02, 1.02 - 1.03), smoking during pregnancy (2.14, 1.97 - 2.32), and pre-eclampsia (1.87, 1.72 - 2.03) were independently associated with a higher likelihood of developing postpartum MAVE. Additionally, those with a history of kidney failure (2, 1.76 - 2.27), liver disease (1.32, 1.11 - 1.56), and heart failure (1.59, 1.35 - 1.86) had higher odds of experiencing MAVE. Furthermore, those with a history of hypertension (1.23, 1.13 - 1.33), diabetes (1.30, 1.17 - 1.45), obesity (1.31, 1.22 - 1.41), and coagulopathy (2.36, 2.17 - 2.57) were more likely to experience MAVE. Conclusions: Migraine seems to be independently associated with a higher risk of post-partum MAVE. Further studies are needed to assess the utility of extended workup for evaluating the risk of MAVE among pregnant females with migraines.