Pregnancy-Associated Stroke in Women With Preeclampsia

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Infection and prothrombotic states were 2 predictors of pregnancy-associated stroke.
Infection and prothrombotic states were 2 predictors of pregnancy-associated stroke.

Women with preeclampsia have an up to 6-fold increased risk of pregnancy-associated stroke. This risk is even higher in women with chronic hypertension, infection, coagulopathies, and prothrombotic conditions, according to a study published in Stroke.

Preeclampsia is a common hypertensive disorder of pregnancy that is characterized by dysfunction of multiple organ systems. This condition affects up to 8% of pregnant women and accounts for more than one-third of pregnancy-related strokes. Because the overall incidence of pregnancy-associated stroke is low (34.2 per 100,000 deliveries), data are lacking regarding risk factors for stroke during pregnancy in women with preeclampsia.

Eliza C. Miller, MD, from Columbia University in New York City, and colleagues sought to determine the modifiable risk factors for pregnancy-associated stroke in women with preeclampsia using data from a state-wide inpatient database.

Of 88,857 women with preeclampsia, 197 (0.2%) experienced pregnancy-associated stroke.

Independent risk factors for pregnancy-associated stroke in women with preeclampsia included prothrombotic states (odds ratio [OR], 3.5; 95% CI, 4.6-11.3), chronic hypertension (OR, 3.2; 95% CI, 1.8-5.5), coagulopathies (OR, 3.1; 95% CI, 1.3-7.1), and infections at the time of admission (OR, 3.0; 95% CI, 1.6-5.8).

Infection and prothrombotic states were important predictors of pregnancy-associated stroke in women with mild preeclampsia (n=57) and severe preeclampsia (n=140), respectively. Chronic hypertension was a risk factor for pregnancy-associated stroke for both subgroups.

Dr Miller indicated that while this study identified risk factors for pregnancy-related stroke in women with preeclampsia, the pathogenesis of stroke in preeclampsia is not fully understood.

“We still do not have a good handle on the pathophysiology of preeclampsia, especially its cerebrovascular complications. This is a very complex multi-system disease,” Dr Miller told Cardiology Advisor. “I think the infection idea is very interesting — preeclampsia is an inflammatory condition, so it may be that having an infection increases that inflammatory response and triggers complications like stroke. I think we still have a lot of work to do and it is going to take a multidisciplinary research effort.”

Dr Miller also highlighted the importance of monitoring women with preeclampsia for stroke symptoms during the postpartum period, since two-thirds of pregnancy-associated strokes occurred after delivery in this study.

“Preeclampsia carries a risk of pregnancy-associated stroke which does not end with delivery,” Dr Miller said. “It's important that clinicians be aware of this so that they can counsel their patients about stroke signs and symptoms before discharge from the hospital after delivery.”

“This is a vulnerable time for a woman because the focus has shifted from her own health to the care of her newborn. She may ignore a terrible headache or vision changes, thinking it is just part of recovering from giving birth.”


References:

Miller EC, Gatollari HJ, Too G, et al. Risk factors for pregnancy-associated stroke in women with preeclampsia. [published online May 25, 2017]. Stroke. doi10.1161/STROKEAHA.117.017374


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