Can Pregnancy Up the Risk for Recurrent CeAD, Stroke?
Pregnancy was not associated with an increased risk for recurrent cervical artery dissection (CeAD), stroke, or death up to 5 years later in women with a history of CeAD, a new cohort study showed.
METHODOLOGY:
Researchers conducted a registry-based, explorative cohort study across 33 stroke centers in nine countries using data collected between 1990 and 2023.
1013 women with a history of CeAD (median age, 42 years) and at least 6 months of follow-up data were included. Of these, 114 became pregnant during the study (pregnancy group), and 899 did not (nonpregnancy group).
The primary outcome was a composite of recurrent CeAD, stroke of any type, and all-cause mortality. Secondary outcomes were individual components of the composite outcome.
The median follow-up duration was 5.3 years, and the analysis was adjusted for age.
TAKEAWAY:
The composite outcome was observed in 9% of the pregnancy group, including seven cases of recurrent CeAD, two of ischemic stroke, and one of intracerebral hemorrhage (ICH), vs 7% of the nonpregnancy group, which included 32 cases of recurrent CeAD, 26 of ischemic stroke, four of ICH, and five of death (adjusted hazard ratio [aHR], 0.77; 95% CI, 0.38-1.56).
Five of the 10 primary outcome events in the pregnancy group occurred during the postpartum period, suggesting increased vulnerability during this phase.
Secondary outcomes also showed no significant between-group differences in risk for recurrent CeAD (aHR, 1.0), ischemic stroke (aHR, 0.5), and ICH (aHR, 1.0).
The incidence rate of recurrent CeAD was 0.7% per patient-year in the pregnancy group vs 0.5% per patient-year in the nonpregnancy group.
IN PRACTICE:
'These findings suggest that pregnancy is not associated with an increased risk of subsequent events; therefore, prior CeAD does not justify advising against future pregnancy,' the investigators wrote, adding that the results 'may be helpful for individual counseling and family planning for women with prior CeAD.'
SOURCE:
This study was led by Sandro K. Fischer, MMed, University Hospital Basel, Basel, Switzerland. It was published online on July 17 in JAMA Network Open.
LIMITATIONS:
This study was limited by its exploratory nature, potential referral bias, underrepresentation of women at a higher presumed recurrence risk in the pregnancy group, and a lack of central data monitoring and adjudication of diagnoses, exposure variables, and outcome events. Additionally, the small number of events may have led to statistical imprecision.
DISCLOSURES:
This study was funded by the Swiss Heart Foundation and the Associazione per la Lotta alla Trombosi e alle Malattie Cardiovascolari. Several investigators reported having financial ties with various sources, including pharmaceutical companies. Some investigators also reported holding industry‐related patents and having employment or advisory ties with pharmaceutical companies outside the submitted work. Details are fully listed in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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