Stroke during pregnancy makes subsequent pregnancies high-risk

Women who have had an ischaemic stroke (IS) during a pregnancy face increased risk of complications in subsequent pregnancies, according to a study.

Researchers used data from the Medical Birth Register and Hospital Discharge Register. They identified 90 women who had IS during pregnancy or puerperium (mean age 31 years, 16.3 percent had obesity) and matched them with 265 controls without maternal stroke (mean age 30.9 years, 12 percent had obesity).

Age and most traditional risk factors of stroke (obesity, smoking, dyslipidaemia, and diabetes) during the index pregnancy did not significantly differ between women with maternal IS and controls. During the index pregnancy, women with maternal ischaemic stroke were more likely to have migraines, hypertensive disorders of pregnancy, and undergo caesarean delivery.

Compared with controls, women with maternal IS were less likely to have at least one subsequent pregnancy (38.9 percent vs 51.7 percent; adjusted odds ratio [aOR], 0.55, 95 percent confidence interval [CI], 0.32–0.93) and were more likely to have multiple induced abortions (aOR, 6.24, 95 percent CI, 1.12–34.88). Three women had a recurrent maternal IS or transient ischaemic attack (8.6 percent).

Women with maternal IS more commonly had diabetes during pregnancy (29.1 percent vs 13.6 percent; aOR, 2.77, 95 percent CI, 1.17–6.59) and hypertensive disorders of pregnancy (12.7 percent vs 4.5 percent; aOR, 3.57, 95 percent CI, 1.02–12.51) relative to controls.

In the first subsequent pregnancy, the incidence of perinatal deaths was significantly higher in the maternal IS group than in the control group (5.9 percent 0 percent; p=0.042). Most women used antithrombotic medication (87.9 percent) in the first subsequent pregnancy, but the use of this medication declined in later pregnancies. The use of other secondary preventive medications was uncommon both before and during pregnancy.