Pregnancy Complications Tied to Increased Stroke Risk

Medscape

3 days ago

TOPLINE:
A history of pregnancy complications was associated with an increased risk for ischemic stroke, particularly atherothrombotic stroke, a new cohort study showed. The risk was especially high among women with complications such as hypertensive disorders of pregnancy, small-for-gestational-age births, and preterm deliveries.
METHODOLOGY:
The case-cohort study included more than 300 women (age, 18-49 years; 736 total previous pregnancies) with first-ever ischemic stroke from the prospective ODYSSEY study.
These women were frequency-matched for age at the most recent pregnancy with more than 700 women (1431 previous pregnancies) without ischemic stroke from the PRIDE study.
Pregnancy complications included miscarriage (at < 20 weeks of gestation), hypertensive disorders of pregnancy, small-for-gestational-age birth, preterm birth (at < 37 weeks of gestation), gestational hypertension, preeclampsia, gestational diabetes, and stillbirth (at ≥ 20 weeks of gestation).
The cause of the stroke was determined using the modified Trial of Org 10172 in Acute Stroke Treatment classification.
TAKEAWAY:
The median interval between the first pregnancy and stroke occurrence was 16 years. The median birth weight of the first child born to women with ischemic stroke was lower than that of women without stroke (3190 vs 3400 g).
A higher proportion of women with ischemic stroke than those without stroke experienced one or more pregnancy complications (51% vs 31%). Ischemic stroke at a young age was significantly associated with hypertensive disorders in multiple pregnancies and in a single pregnancy (odds ratios [ORs], 3.9 and 2.0, respectively), preeclampsia (OR, 4.0), preterm birth (OR, 2.7), gestational diabetes (OR, 2.6), stillbirth (OR, 4.8), miscarriage (OR, 1.3), and small-for-gestational-age births (OR, 2.8).
Women with ischemic stroke due to large artery disease were more likely than those with cryptogenic stroke to have a history of hypertensive disorders in multiple and single pregnancies (ORs, 3.4 and 3.0, respectively), small-for-gestational-age births (OR, 1.9), or preterm deliveries (OR, 2.1), suggesting an increased risk for future atherosclerotic disease in these patients.
More than 40% of women with cryptogenic stroke experienced one or more pregnancy complications, suggesting potential underlying atherosclerotic mechanisms behind some of these strokes, the investigators noted.
IN PRACTICE:
'Fortunately, the overall risk of stroke remains low. But we see that certain pregnancy problems can serve as an early warning,' co-investigator Frank-Erik de Leeuw, PhD, Radboud Institute of Medical Innovation, Nijmegen, the Netherlands, said in a press release.
'If doctors are aware of this medical history, they can start preventive care earlier,' de Leeuw added.
SOURCE:
The study was led by Esmée Verburgt, Radboud Institute of Medical Innovation, Nijmegen, the Netherlands. It was published online on August 6 in Neurology.
LIMITATIONS:
The study relied on self-reporting of pregnancy complications, which may have led to over- or underestimation of complication occurrence. The prospective recruitment of participants in the PRIDE study meant that some participants could potentially develop ischemic stroke at a young age during follow-up. Additionally, the study did not account for confounding cardiovascular risk factors.
DISCLOSURES:
The study was funded by Radboud University Medical Center, the Dutch Heart Foundation, and Vidi. The investigators reported having no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.