Stroke recurrence in pregnancy: Experience at a regional referral center

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Abstract

Background

Although stroke is more common with advancing age, especially in the elderly, women of reproductive age may still suffer from stroke, and from its deleterious consequences. Women of reproductive age who suffer a stroke may do so either due to a specific predisposition, or due to pregnancy-related hypertensive emergencies.

Objective

To assess the risk of stroke recurrence in pregnancy and the postpartum period in women who have suffered a stroke before pregnancy.

Study design

This was a retrospective cohort study conducted at Thomas Jefferson University Hospital from January 2005 to December 2015. This is a tertiary referral center for high-risk obstetrics and one of the largest stroke referral centers for neurosurgery. All consecutive pregnant women that had a viable pregnancy (≥24 weeks of gestation) and a history of stroke prior to pregnancy were identified. The primary outcome of this study was stroke recurrence in pregnancy or the postpartum period defined as 6 weeks after delivery.

Results

Forty-eight pregnancies with a history of stroke before pregnancy were identified in 24 women. Thirty-one pregnancies (64.6%) had a history of an ischemic stroke, 11 (22.9%) had a history of transient ischemic attack, and 6 (12.5%) had a history of a hemorrhagic stroke. There was no stroke recurrence during pregnancy or the postpartum period for the three groups of stroke. In the ischemic stroke group, 8 (25.8%) had recurrence in the non-pregnant state compared to none in the TIA and the hemorrhagic stroke group.

Conclusion

There was no stroke recurrence during pregnancy or the postpartum period for the three groups of stroke.

Introduction

Although stroke is more common with advancing age, especially in the elderly, women of reproductive age may still suffer from stroke, and from its deleterious consequences [1]. Women of reproductive age who suffer a stroke may do so either due to a specific predisposition, such as a brain aneurysm or a specific clotting disorder, or due to pregnancy-related hypertensive emergencies [2].

Hypertensive disorders in pregnancy remain a major cause of maternal morbidity mortality in the United States [3]. Stroke in pregnancy and the peripartum period is a known complication of hypertensive emergencies, and continues to be a serious clinical challenge despite national safety bundles to minimize the deleterious effects of such acute emergencies [4].

Fortunately, many women of reproductive age who suffered a stroke, have a good prognosis [5]. They often present either for prenatal or preconception counseling to assess the maternal risks to help in their decision-making whether to start, continue or terminate a pregnancy. While counseling women who have suffered a stroke may be guided by the patient’s predisposing risk factors, it remains challenging to counsel patients about the possibility of stroke recurrence in pregnancy.

Thus, the aim of this study was to assess the risk of stroke recurrence in pregnancy and the postpartum period in women who have suffered a stroke before pregnancy.

Section snippets

Materials and methods

This was a retrospective cohort study conducted at Thomas Jefferson University Hospital from January 2005 to December 2015. This is a tertiary referral center for high-risk obstetrics and one of the largest stroke referral centers for neurosurgery. This study was approved by the Institutional Review Board of Thomas Jefferson University.

All consecutive pregnant women that had a viable pregnancy (≥24 weeks of gestation) and a history of stroke prior to pregnancy were identified. Only women with

Results

Forty-eight pregnancies with a history of stroke before pregnancy were identified in 24 women. The primary outcome of stroke recurrence of these patients was available for all patients. Obstetrical outcome including mode of delivery was available for 42 pregnancies.

Thirty-one pregnancies (64.6%) had a history of an ischemic stroke, 11 (22.9%) had a history of transient ischemic attack, and 6 (12.5%) had a history of a hemorrhagic stroke.

Baseline characteristics of the three groups of stroke are

Discussion

While the risk of stroke is low among women of reproductive age [6], this cohort of women does present with pregnancies that are clinically challenging in their management given the concern for stroke recurrence during pregnancy. In our study we found a 0% recurrence rate of stroke during pregnancy. This is consistent with other studies, such as a French study that reviewed 187 pregnancies with a history of ischemic stroke and found a recurrence rate of 1% [7].

A more recent larger study, this

Disclosure statement

The authors report no conflicts of interest

Financial support

No specific funding was received for this study

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