Pregnancy complications tied to lifetime stroke risk
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Key takeaways:
- People with at least one adverse pregnancy outcome have higher lifetime stroke risk vs. people with no pregnancy complications.
- Stroke risk increased with subsequent pregnancies with complications.
People who experience adverse pregnancy outcomes develop cerebrovascular disease at younger ages, with the earliest onset and greatest risk seen in those with multiple pregnancies affected by complications, researchers reported.
The researchers said mechanistic studies are needed to better understand the pathways by which pregnancy complications, including gestational hypertension, preeclampsia and preterm birth, may contribute to early-onset cerebrovascular disease.
Data were derived from Miller EC, et al. Stroke. 2023;doi:10.1161/STROKEAHA.123.043052.
“We understand from past studies in the U.S. that women have a greater risk of experiencing a stroke and a disproportionate burden of disability after a stroke than men,” Natalie A. Bello, MD, MPH, director of hypertension research in the Smidt Heart Institute at Cedars-Sinai, said in a press release. “This study deepens our understanding of why women may be more greatly impacted by stroke risk and opens the door to more meaningful conversations about pregnancy history among patients and their clinicians.”
In a longitudinal study, Bello and colleagues analyzed data from 144,306 women with 316,789 births, using data from the FinnGenn study, which includes nationwide health registry data. Researchers defined adverse pregnancy outcomes as a pregnancy affected by gestational hypertension, preeclampsia, eclampsia, preterm birth, a small-for-gestational-age infant or placental abruption. Stroke was defined as the first hospital admission for ischemic stroke or nontraumatic intracerebral or subarachnoid hemorrhage, excluding stroke during pregnancy or within 1 year postpartum. Researchers used Kaplan-Meier survival curves and linear models to assess the relationship between adverse pregnancy outcomes and future stroke.
The findings were published in Stroke.
During a median follow-up of 30.7 years; 17.9% of participants had at least one pregnancy with an adverse pregnancy outcome and 2.9% experienced an adverse pregnancy outcome during two or more pregnancies. Researchers found that women with an adverse pregnancy outcome also had more comorbidities, including obesity, hypertension, CVD and migraine.
The median age at first stroke was 58 years among women who did not experience an adverse pregnancy outcome; 55 years among women with one adverse pregnancy outcome; and 52 years for women with recurrent adverse pregnancy outcomes.
In models adjusted for sociodemographic characteristics and stroke risk factors, risk for stroke was greater in women with one adverse pregnancy outcome (adjusted HR = 1.3; 95% CI 1.2-1.4) and recurrent adverse pregnancy outcomes (aHR = 1.4; 95% CI, 1.2-1.7) compared with women with uncomplicated pregnancies.
Additionally, women with recurrent adverse pregnancy outcomes had more than twice the stroke risk before age 45 years, with an adjusted HR or 2.1 (95% CI, 1.5-3.1) compared with women with no adverse pregnancy outcomes.
“This emphasizes the need for women to share their pregnancy history with their doctors, especially if they experience neurologic symptoms concerning for stroke or transient ischemic attack that tends to resolve within minutes to hours,” Bello said in the release.
The researchers noted that observational data suggest a possible role for aspirin in stroke risk reduction for those with a history of hypertensive disorders of pregnancy.
“Our data suggest that those who experience one or more adverse pregnancy outcomes are at high risk for early onset of symptomatic cerebrovascular disease; thus, randomized clinical trials for primary stroke prevention in this high-risk population may be feasible and should be considered,” the researchers wrote.
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