Ongoing counseling essential to reduce risks after stroke during pregnancy
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Patients who survive a pregnancy-associated stroke are at lower risk for death and readmission compared with nonpregnant patients with stroke at 1 year; however, their risks were similar with longer follow-up, researchers reported.
Additionally, pregnant patients with stroke had more than fivefold higher risks for death and readmission compared with pregnant patients without stroke at 1 year, with the association persisting for a decade.
“Even though pregnancy is often thought of as a ‘temporary stressor,’ we found that patients with stroke during pregnancy are at higher risk for long-term adverse health outcomes and their risk of adverse health outcomes, including death and hospitalization, is in fact similar to young patients with stroke without pregnancy,” Amy Yu, MD, MSc, assistant professor of medicine (neurology) at the University of Toronto and a neurologist at Sunnybrook Health Sciences Centre, told Healio. “Therefore, ongoing counseling about healthy lifestyle, screening and treating CVD risk factors after the pregnancy concludes is essential.”
In a retrospective database analysis, Yu and colleagues compared data from 217 pregnant adults with stroke between 2002 and 2020 in Ontario, Canada, with two comparison groups: 7,604 nonpregnant women with stroke and 1,496,256 pregnant patients without stroke.
“The first cohort comprised patients with pregnancy-associated stroke, defined as any hospitalization with a diagnosis of stroke during pregnancy, delivery, or up to 6 weeks postpartum,” the researchers wrote. “The second cohort comprised patients admitted for an in-hospital livebirth, stillbirth, or intentional pregnancy termination on or after 20 completed weeks of gestation. The third cohort comprised nonpregnant young female patients hospitalized with a most responsible diagnosis of stroke.”
Researchers followed patients who survived the index admission until 2021 for the composite outcome of death and all-cause nonpregnancy readmission.
Of the 202 pregnant patients with stroke who survived the index stroke admission, 41.6%, or 6.8 per 100 person-years, died or were readmitted during follow-up.
At 1 year, pregnant patients with stroke had a lower HR for death and all-cause readmission compared with nonpregnant patients with stroke (HR = 0.64; 95% Cl, 0.44-0.94), but this association did not persist during longer-term follow-up.
Conversely, pregnant patients with stroke had a higher HR for death and readmission compared with pregnant patients without stroke at 1-year follow-up (HR = 5.7; 95% Cl, 3.04-10.66), with the association persisting for a decade.
“By having two comparison groups, we identified differences in the relative long-term hazard of death and readmission between these patient groups,” the researchers wrote. “Taken together, our findings suggest that stroke in young females are associated with increased risk of long-term adverse health outcomes regardless of pregnancy status. Our observations raise the concern that risk factors for stroke thought to be ‘pregnancy-specific’ or temporarily present during the pregnancy may in fact continue to negatively impact health even after the pregnancy and childbearing concludes.”
The researchers noted that the data highlight a critical need for transitioning care postpartum to primary care or specialty neurology or internal medicine clinics to facilitate screening and treatment of vascular risk factors, educate and support healthy behaviors, and individualize care and treatment.
For more information:
Amy Yu, MD, can be reached at amyyx.yu@utoronto.ca.
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