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Pregnancy at older age may increase risk for future stroke
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Women who become pregnant at age 40 years and older face a greater risk for stroke later in life compared with women who become pregnant at a younger age, according to research presented at the International Stroke Conference.
Adnan I. Qureshi
“We already knew that older women were more likely than younger women to experience health problems during their pregnancy. Now, we know that the consequences stretch years into the future,” Adnan I. Qureshi, MD, executive director of the Zeenat Qureshi Stroke Institute in St. Cloud, Minnesota, said in a press release.
This finding is important because an increasing number of women are choosing to have children after age 40, according to Qureshi.
The researchers analyzed data from 72,221 women aged 50 to 79 years enrolled in the Women’s Health Initiative observational study. Of these, 3,306 women reported pregnancies at an advanced age (≥ 40 years). The researchers compared rates of stroke, MI and CV death over a 12-year period between women who became pregnant after and before age 40.
Pregnancy at an advanced age was associated with increased risk for ischemic stroke (2.4% vs 3.8%), hemorrhagic stroke (0.5% vs. 1%), MI (2.5% vs. 3%) and CV death (2.3% vs. 3.9%; P < .0001 for all) compared with pregnancy before age 40.
In multivariate analyses, women who became pregnant at an advanced age were 60% more likely to have a hemorrhagic stroke (HR = 1.6; 95% CI, 1.1-2.4), after adjustment for age, race/ethnicity, congestive HF, systolic BP, atrial fibrillation, alcohol use and cigarette smoking. The researchers observed no significant difference in risk for ischemic stroke, MI and CV death in women pregnancy in advanced age after adjusting for potential confounders, according to the findings.
The increased risk for ischemic stroke in women who became pregnant at an advanced age were linked to well-known CV risk factors, including high BP, diabetes and high cholesterol, according to the researchers. However, these risk factors did not explain the link between pregnancy at an advanced age and hemorrhagic stroke.
“The practical implications of the current findings need to be determined. Pre-conception counselling regarding the risks of pregnancy with advanced maternal age, promotion of optimal health and weight, and screening for concurrent medical conditions such as hypertension and diabetes is recommended for women aged > 40 years. Whether information regarding the long-term increased risk of cardiovascular diseases should be included in the pre-conception counselling needs to be considered further? The higher prevalence of certain cardiovascular risk factors in later life among women with last pregnancy at age ≥40 years would suggest a targeted cardiovascular assessment at regular intervals may be considered.” Qureshi said in the release. – by Tracey Romero
Reference:
Qureshi AI, et al. Poster WMP50. Presented at: International Stroke Conference; Feb. 16-19, 2016; Los Angeles.
Disclosures: Qureshi reports no relevant financial disclosures.
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Ralph L. Sacco, MD, MS, FAHA, FAAN
The study showed that women who had a pregnancy over age 40 years had a greater risk for stroke, but mainly hemorrhagic stroke types when in their postmenopausal years. The study is very limited and cannot inform us about why this association exists. Pregnancy in older women can be associated with other CV risks including hypertension. We need to effectively treat stroke risk factors in all women, but possibly be even more diligent among women who have had a child over the age of 40 years.
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