title: Trimester-specific blood pressure levels and hypertensive disorders among pregnant migraineurs.
abstract: OBJECTIVE
  We evaluated the influence of physician-diagnosed migraine on blood pressure levels and the risk of hypertensive disorders of pregnancy in a clinic-based prospective cohort study of 3373 healthy pregnant women.
  
  
  BACKGROUND
  The relationship between migraine and blood pressure is controversial with results from several studies suggesting positive associations, while others suggest null or inverse associations. To our knowledge, no previous study has investigated blood pressure profiles among pregnant migraineurs.
  
  
  METHODS
  We abstracted blood pressure values and delivery information from medical records of women presenting to prenatal clinics in Washington State. Mean blood pressure differences for pregnant migraineurs and non-migraineurs were estimated in regression models, using generalized estimating equations. We calculated odds ratios and 95% confidence intervals (95% CIs) for gestational hypertension and preeclampsia in relation to migraine status.
  
  
  RESULTS
  Mean first, second, and third trimester systolic blood pressures (SBP) were elevated among pregnant migraineurs as compared with non-migraineurs. Migraineurs had higher mean third trimester SBP (4.08 mmHg) than non-migraineurs. Trimester-specific diastolic blood pressure (DBP) values were variably related with migraine status. Mean first (0.82 mmHg) and third (2.39 mmHg) trimester DBP were higher, and second trimester DBP values were lower (-0.24) among migraineurs as compared with non-migraineurs. Migraineurs had a 1.53-fold increased odds of preeclampsia (95% CI 1.09 to 2.16). Additionally, migraineurs who were overweight or obese had a 6.10-fold increased odds of preeclampsia (95% CI 3.83 to 9.75) as compared with lean non-migraineurs.
  
  
  CONCLUSIONS
  Pregnant migraineurs had elevated blood pressures, particularly SBP measured in the third trimester, and a higher risk of preeclampsia than pregnant women without migraine. Observed associations were more pronounced among overweight or obese migraineurs. Our findings add to the accumulating evidence of adverse pregnancy outcomes among migraineurs.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA. mwilliam@uw.edu
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
authors.forename: B Lee
authors.initials: BL
authors.lastname: Peterlin
authors.forename: Bizu
authors.initials: B
authors.lastname: Gelaye
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Enquobahrie
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Miller
authors.forename: Sheena K
authors.initials: SK
authors.lastname: Aurora
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology*; D008881:Migraine Disorders / Q000453:epidemiology / Q000503:physiopathology*; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000503:physiopathology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000503:physiopathology*; D011264:Pregnancy Trimesters / Q000502:physiology*; D012307:Risk Factors