Maternal migraine, vascular comorbidities, and prematurity: exploring overlooked associations in pregnancy

Prematurity remains a leading cause of neonatal morbidity and mortality, with lasting implications for neurodevelopment and lifelong health. This study aimed to investigate maternal and fetal factors associated with preterm birth within a cohort of pregnant women affected by migraine, with particular focus on vascular and metabolic comorbidities potentially contributing to adverse pregnancy outcomes.

We performed prospective cohort study. Pregnant women presenting in the first trimester (≤11 weeks gestation) with a history of migraine prior to conception and at least one migraine attack during the first trimester were enrolled. Participants underwent neurological evaluation to exclude secondary headache disorders and completed structured questionnaires on migraine frequency and intensity pregestation and during pregnancy. Participants were stratified by gestational age at delivery into preterm (<37 weeks) and term (≥37 weeks) groups. Maternal, fetal, and pregnancy-related variables assessed included maternal age, parity, maternal obesity, gestational weight gain, fetal growth restriction, delivery mode, pregnancy-induced hypertension, and gestational diabetes mellitus.

A total of 400 women were included, of whom 65 delivered preterm. Statistically significant associations with preterm delivery were observed for pregnancy-induced hypertension (p < 0.001), gestational diabetes mellitus (p < 0.001), maternal obesity (p = 0.021), excessive gestational weight gain (p < 0.001), fetal growth restriction (p < 0.001), parity (p < 0.001), delivery mode (p < 0.001), and migraine frequency (p = 0.015) and intensity (p = 0.020) worsening during pregnancy. Excessive gestational weight gain emerged as a key modifiable risk factor. Women who delivered preterm reported more frequent and intense migraine attacks compared with term deliveries.

Our findings support the hypothesis that migraine is a systemic vascular condition with significant implications for pregnancy outcomes. The coexistence of migraine with pregnancy-induced hypertension, gestational diabetes mellitus and maternal obesity suggests that shared pathophysiological mechanisms may increase the risk of prematurity. While pre-pregnancy obesity alone was not an independent predictor, gestational weight gain represents a critical modifiable factor. These results underscore the need for individualized, multidisciplinary prenatal care for women with migraine, emphasizing vascular risk assessment, blood pressure monitoring, weight management, and optimized migraine control. Future studies are warranted to clarify causal mechanisms and develop safe therapeutic strategies to protect both maternal and fetal health.