When compared with the general population, young women with stroke have more pregnancy loss throughout their lives, according to research published in the April issue of Stroke. After stroke, nulliparous women more frequently experience serious pregnancy complications, compared with the general population. “We found that one out of three women experiences a serious pregnancy complication after stroke,” said Mayte E. van Alebeek, MD, of the Department of Neurology at the Donders Institute for Brain, Cognition, and Behavior, Center for Neuroscience in Nijmegen, the Netherlands, and colleagues.
“Our cohort shows high rates of miscarriages, multiple miscarriages, and extremely high rates of fetal death,” said Dr. van Alebeek. “Our study provides insight about the frequency of pregnancy complications in women who experience a stroke at young age.”
A Prospective Stroke Study
Although 16 to 59 per 100,000 women of childbearing age have stroke every year, there is limited research about the risks of future pregnancy complications after stroke. Dr. van Alebeek and colleagues hypothesized that women with stroke have an increased risk of future pregnancy complications. To test this hypothesis, they conducted a prospective study to investigate the prevalence of pregnancy complications and pregnancy loss in young women before, during, and after ischemic stroke or transient ischemic attack (TIA).
The study was a part of the Dutch Follow-Up of TIA and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study. Eligible participants were women with first-ever TIA or ischemic stroke who reported that they had been pregnant at least once. Exclusion criteria were cerebral venous sinus thrombosis and retinal infarction. The investigators defined TIA as rapidly evolving focal neurologic deficit without positive phenomena such as twitches, jerks, or myoclonus, with vascular cause only, and persisting for fewer than 24 hours. They defined stroke as focal neurologic deficit persisting for more than 24 hours.
The primary outcome was the occurrence of pregnancy complications (ie, gestational hypertension; preeclampsia; hemolysis, elevated liver enzymes, low platelet count [HELLP] syndrome; preterm delivery; gestational diabetes mellitus; and miscarriage). The secondary outcome was the risk of any vascular event after stroke, stratified by the occurrence of pregnancy complications. Researchers identified the occurrence of recurrent vascular events during a telephone assessment.
Miscarriages Occurred in 35.2% of Women With Stroke
Two hundred thirteen participants completed follow-up assessment on vascular events and pregnancy complications. The mean age at event was 39.6, with a mean follow-up of 12.7 years. The number of pregnancies was unknown for three women. Of the remaining 210 women, 569 pregnancies resulted in 425 live births. All pregnancy complications were equally reported in the nulliparious (patients who experienced stroke/TIA before their first pregnancy of a live-born child), primi/multiparous (patients who have had one more pregnancies), and the gravidas (during pregnancy or postpartum, defined as within six weeks after delivery) groups.
Miscarriage occurred in 35.2% of women with stroke vs 13.5% of the Dutch population. Fetal death occurred in 6.1% of women with stroke vs 0.9% of the Dutch population.
Compared with the Dutch population, nulliparous women after stroke had a high prevalence of hypertensive disorders in pregnancy (12.2% vs 33.3%), HELLP syndrome (0.5% vs 9.5%), and early preterm delivery less than 32 weeks (1.4% vs 9.0%).
In primiparous and multiparous women after stroke, 29 events occurred. None of these events occurred during subsequent pregnancies. A history of hypertensive disorder in pregnancy did not modify this risk.
This is the first study to address the risk of pregnancy complications in a large group of women after their stroke, said the researchers.
These findings “may imply that women with a history of stroke should be put under intensive control of a gynecologist during pregnancy to prevent serious and possibly life-threatening pregnancy complications,” Dr. van Alebeek and his team concluded.
van Alebeek ME, de Vrijer M, Arntz RM, et al. Increased risk of pregnancy complications after stroke: the FUTURE study (Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation). Stroke. 2018;49(4):877-883.