Stroke at fertile age linked to less favourable obstetric prognosis
Women who develop stroke at a young age are at high risk of pregnancy loss throughout their lives as compared with the general population, according to data from the FUTURE* study. Moreover, nulliparous women are more likely to have serious pregnancy complications following stroke.
FUTURE included 213 women with a first-ever ischaemic stroke/transient ischaemic attack (mean age at event, 39.6 years). The primary outcome of pregnancy complications (gestational hypertension, diabetes mellitus, pre-eclampsia, and haemolysis, elevated liver enzymes, low platelet count syndrome) were assessed before, during and after stroke using standardized questionnaires. Secondary outcome was the risk of recurrent vascular events after stroke, stratified by a history of hypertensive disorder in pregnancy.
During a mean follow-up of 9.5 years, miscarriages and foetal death occurred in 35.2 percent and 6.2 percent of the FUTURE population, respectively. In the comparison cohort, the respective outcomes occurred in 13.5 percent and 0.9 percent (p<0.05 for both).
In nulliparous women (n=22) in the FUTURE vs the comparison cohort, there was a high prevalence of hypertensive disorders in pregnancy (33.3 percent vs 12.2 percent; p<0.05), haemolysis, elevated liver enzymes, low platelet count syndrome (9.5 percent vs 0.5 percent; p<0.05) and early preterm delivery <32 weeks (9.0 percent vs 1.4 percent; p<0.05).
In primi/multiparous women (n=141), 29 recurrent cardiovascular events were documented overall. The 20-year cumulative risk of recurrent cardiovascular events after stroke was 35.2 percent (95 percent CI, 21.3–49.0), and a history of a hypertensive disorder in pregnancy exerted no influence on this risk (p=0.62).
The current findings can be used to inform women with stroke who are seeking personalized advice on future pregnancies, researchers said. Specifically, women with a history of stroke should be closely monitored by a gynaecologist during pregnancy to prevent serious and potentially life-threatening pregnancy complications.
*Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation