Headache · 2026
Differential impact of migraine on severe maternal morbidity and postpartum readmissions: Insights from a national cohort study.
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Tram Michelle T, Cheng Nan, Jicha Crystal
Аннотация
OBJECTIVE: This study evaluates severe maternal morbidity (SMM) and hospital readmissions in women with migraine.
BACKGROUND: There has been a rising incidence of SMM and growing urgency to monitor SMM as a measure of maternal outcomes. Migraine is the leading cause of disability in reproductive-aged women and is linked to numerous obstetric comorbidities that likely contribute to SMM, rehospitalization, and resulting healthcare costs. However, population-level data examining these outcomes are limited.
METHODS: Using the 2019 National Readmissions Database, we performed a retrospective cohort analysis of index characteristics and postpartum rehospitalizations for women with migraine from January to November 2019. Baseline demographics, hospital characteristics, and indications for readmission were obtained. Odds of SMM at delivery and 30-day nonelective readmission were compared between women with and without migraine. Validated obstetric comorbidity scores and cost of hospitalization were also compared. Models were adjusted for baseline patient and hospital demographics, method of delivery, body mass index (BMI), aspirin use, and obstetric comorbidities.
RESULTS: Out of all qualifying deliveries in 2019, 22,074 women had migraine (1.2%). Only 14.2% of these women had a specific migraine diagnosis (n = 3145), of whom 61.7% had migraine with aura (MA; n = 1941) and 38.3% had migraine without aura (MO; n = 1204). Overall, women with migraine had higher obstetric comorbidity scores than those without migraine. Higher odds of SMM were also associated with migraine (odds ratio [OR] 1.82, 95% confidence interval [CI] [1.68, 1.96]). However, after additionally adjusting for comorbidities, this relationship was no longer significant. In contrast, migraine was independently associated with greater odds of 30-day postpartum readmission (migraine: adjusted odds ratio [aOR] 1.29, 95% CI [1.17, 1.41]; MO: aOR 1.49, 95% CI [1.02, 2.10]) and higher hospitalization costs (migraine: adjusted incidence rate ratio [aIRR] 1.18, 95% CI [1.17, 1.19]).
CONCLUSION: Women with migraine have higher obstetric comorbidity scores, which may contribute to the elevated risk of SMM. Migraine itself is independently associated with increased 30-day nonelective readmission rates and hospitalization costs. These associations, along with the large number of unspecified migraine diagnoses, highlight the importance of thorough migraine screening and documentation, which may help guide interventions to improve maternal outcomes and reduce healthcare burden.
BACKGROUND: There has been a rising incidence of SMM and growing urgency to monitor SMM as a measure of maternal outcomes. Migraine is the leading cause of disability in reproductive-aged women and is linked to numerous obstetric comorbidities that likely contribute to SMM, rehospitalization, and resulting healthcare costs. However, population-level data examining these outcomes are limited.
METHODS: Using the 2019 National Readmissions Database, we performed a retrospective cohort analysis of index characteristics and postpartum rehospitalizations for women with migraine from January to November 2019. Baseline demographics, hospital characteristics, and indications for readmission were obtained. Odds of SMM at delivery and 30-day nonelective readmission were compared between women with and without migraine. Validated obstetric comorbidity scores and cost of hospitalization were also compared. Models were adjusted for baseline patient and hospital demographics, method of delivery, body mass index (BMI), aspirin use, and obstetric comorbidities.
RESULTS: Out of all qualifying deliveries in 2019, 22,074 women had migraine (1.2%). Only 14.2% of these women had a specific migraine diagnosis (n = 3145), of whom 61.7% had migraine with aura (MA; n = 1941) and 38.3% had migraine without aura (MO; n = 1204). Overall, women with migraine had higher obstetric comorbidity scores than those without migraine. Higher odds of SMM were also associated with migraine (odds ratio [OR] 1.82, 95% confidence interval [CI] [1.68, 1.96]). However, after additionally adjusting for comorbidities, this relationship was no longer significant. In contrast, migraine was independently associated with greater odds of 30-day postpartum readmission (migraine: adjusted odds ratio [aOR] 1.29, 95% CI [1.17, 1.41]; MO: aOR 1.49, 95% CI [1.02, 2.10]) and higher hospitalization costs (migraine: adjusted incidence rate ratio [aIRR] 1.18, 95% CI [1.17, 1.19]).
CONCLUSION: Women with migraine have higher obstetric comorbidity scores, which may contribute to the elevated risk of SMM. Migraine itself is independently associated with increased 30-day nonelective readmission rates and hospitalization costs. These associations, along with the large number of unspecified migraine diagnoses, highlight the importance of thorough migraine screening and documentation, which may help guide interventions to improve maternal outcomes and reduce healthcare burden.