Red flags for pregnant women with headaches

Women who present with an acute headache during pregnancy may have a secondary disorder requiring attention, according to a new single-center retrospective study in Neurology.

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Researchers studied 140 women who presented with an acute headache at the emergency department, labor and delivery triage, or antepartum units at the Jack D Weiler Hospital in Bronx, New York from July 2009 to June 2014 and subsequently had a neurology consult requested. The average age of the women was 29 ± 6.4 years and 56.4% of them presented during the third trimester. Sixty-five percent of diagnoses were primary disorders and 35% were secondary disorders. Demographics, gestational ages, and most headache features were similar across both groups.

Overall, 91.2% of primary disorders were migraine and 51% of secondary headache disorders were hypertensive. Following univariate analysis, secondary headaches were linked to a lack of headache history (36.7% vs 13.2%, P = 0.0012), fever (8.2% vs 0.0%, P = 0.014), abnormal neurologic examination (34.7% vs 16.5%, P = 0.014), seizures (12.2% vs 0.0%, P = 0.0015), and elevated blood pressure (55.1% vs 8.8%, P < 0.0001). The association between a secondary headache and lack of headache history and elevated blood pressure increased following multivariate logistic regression.

The investigators concluded that roughly a third of the headaches were from secondary disorders. They believe that in pregnant patients with headache, vigilance is important in the absence of a history of headache and if a woman has hypertension, seizures, or fever.

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Could phthalates be linked to miscarriage?

A Chinese study suggests that there may be an association between miscarriage and exposure to phthalates, chemicals used in some plastics, solvents, and personal care products. Published in Environmental Science & Technology, the findings are from the first epidemiological study of non-work-related phthalate exposure in a general population.

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For the research, investigators from Peking University analyzed 8 phthalate metabolites in urine from 132 women with clinical pregnancy loss (cases) and 172 women with healthy pregnancies (controls). Using ultraperformance liquid chromatography, 5 phthalates metabolites-monomethyl phthalate (MMP), monoethyl phthalate (MEP), monoisobutyl (phthalate (MiBP), mono-n-butyl phthalate (MnBP), and mono(2-ethylhexyl) phthalate (MEHP)-were detected in 95% of the samples. The highest median concentrations were of MnBP, at 51.0 µg/g of creatinine.

In the women with pregnancy loss, concentrations of the chemicals were significantly higher than in their counterparts with healthy pregnancies: 18.7.7 µg/g versus 15.7 µg/g for MEP, 23.3 µg/g versus 19.4 µg/g for MiBP, and 58.2 µg/g versus 43.9 µg/g for MnBP; P<0.05. From the first to fourth quartiles of MEP, MiBP, and MnBP concentrations (P<0.005 for trend), the authors said, increasing risks of clinical pregnancy loss were observed. They concluded that “exposure to MEP, MiBP, and MnBP was associated with an increased risk of clinical pregnancy loss.”

As noted on the webpage of the Centers for Disease Control and Prevention, some types of phthalates have been shown to affect the reproductive systems of laboratory animals. Research has found that adult women have higher levels of urinary metabolites than men for phthalates that are used in soaps, body washes, shampoos, cosmetics, and similar personal care products. More studies are needed to assess the human health effects of exposure to phthalates.

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Hypertension in pregnancy and sibling risk

Hypertension during pregnancy may signal a risk for hypertension in the woman’s siblings, according to a new study in the Journal of the American Society of Nephrology.

Researchers at the Mayo Clinic looked at data from the Genetic Epidemiology Network of Arteriopathy study on 1477 female and 919 male siblings of 252 women who had hypertension during pregnancy. None of the siblings had a history of hypertension.

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Roughly 72% of the women who were hypertensive during pregnancy went on to develop hypertension before age 60, compared to roughly 62% of women who had no history of high blood pressure. In addition, when compared to their sisters who had no high blood pressure during pregnancy, women with a history of high blood pressure while pregnant were 75% more likely to develop hypertension later in life.

Sisters of women with hypertension during pregnancy were 15% more likely to develop high blood pressure, whereas the brothers of such women were 24% more likely to develop hypertension than those without such a sibling. Also, brothers of hypertensive pregnant women were more likely to develop cardiovascular disease than those who didn’t have such a sibling.

Investigators concluded that a history of hypertension in pregnancy leads to a future risk of developing hypertension later in life. A history of a sibling with high blood pressure while pregnant poses a novel risk factor for developing hypertension later in life.