Certain adverse pregnancy outcomes tied to stroke risk

Preeclampsia and gestational diabetes increased odds of an event by 50%.

Women who had preeclampsia or gestational diabetes during pregnancy are at a greater risk of stroke later in life.

Researchers at Duke University Medical Center found that women who had strokes were 70% more likely to have had pregnancy complications than average women.

“Apart from our study, basic science evidence shows that for women with preeclampsia, even though specific metabolic abnormalities crescendo during pregnancy, disturbances in vascular function and markers of endothelial dysfunction persist post-pregnancy,” Monique Chireau, MD, told Cardiology Today.

Chireau, assistant professor in the department of obstetrics and gynecology at Duke University Medical Center, and colleagues used Duke’s Perinatal and Health Services Outcomes Database to conduct a case-control study to examine adverse pregnancy outcomes and their relationship to stroke. They presented their findings at the 130th Annual Meeting of the American Neurological Association.

The database included 42,263 women who gave birth at Duke University Medical Center between 1979 and 2005; 164 of these had a stroke and were matched by age and month/year at delivery to women without stroke. The stroke occurred a mean of 13.5 years following delivery and at an average age of 40.

Early onset stroke

“It was absolutely startling to find. Physicians just don’t think of young women having that kind of stroke risk,” Chireau said.

“We are concerned because our initial review of the evidence suggests that when women come in with a stroke in their 40s, they subsequently do very poorly.”

The odds of having a stroke were doubled with the occurrence of preeclampsia and gestational diabetes. Women who have true gestational diabetes in pregnancy have a 50% risk of progressing to frank diabetes within 10 years, Chireau said.

“Endothelial dysfunction appears to be a major culprit,” she said. “Another culprit is hypertension — that is, some percentage of women with preeclampsia had undiagnosed chronic hypertension before their pregnancy. But it’s likely that we haven’t identified all the variables.”

In addition, researchers also found a marked racial disparity. Regardless of adverse pregnancy outcomes, 73% of the women who had a stroke were black. When data were stratified for adverse outcomes, the disparity was less prominent: two-thirds were black, one-third white.

There was also a disparity in terms of insurance status; a majority of the women who had a stroke were on Medicaid.

It is important to find out if underlying metabolic abnormalities found during pregnancy are a result of the pregnancy, or if the pregnancy is a marker for the abnormalities.

“A key issue for internists and OB/GYNs is to recognize that these adverse pregnancy complications are in fact markers for risk. We have not traditionally thought of adverse pregnancy outcomes being risk markers for long-term cardiovascular disease,” she said.

If a woman has had adverse pregnancy outcomes she should have careful follow-up to ensure that she does not have undiagnosed hypertension or diabetes, or other signs that she is at higher risk for future cardiovascular events.

“We would do well to alert these women to the fact that because they have had these outcomes, they should seek follow-up examinations,” Chireau said. – by Leah Smith

For more information:

• Chireau M, Bushnell C, Brown H, et al. Adverse pregnancy outcomes are associated with stroke risk later in life. Presented at the 130th Annual Meeting of the American Neurological Association. September 25-28, 2005. San Diego.