Risk of stroke in women under 50 could be elevated for those who have experienced high-risk pregnancy complications
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Women who have experienced pregnancy complications, including stillbirth, face significantly increased long-term cardiovascular risks, particularly for ischemic strokes and other cardiovascular events later in life.
A study conducted by researchers in the Netherlands has shed light on this issue. The research focused on over 1,000 women aged 18-49 who had at least one pregnancy, examining the occurrence of pre-eclampsia, pre-term birth, small babies for gestational age, gestational diabetes, miscarriage, and stillbirth in women who had strokes.
The findings suggest that pregnancy complications such as hypertensive disorders of pregnancy (HDP), preterm birth, small-for-gestational-age (SGA) births, gestational diabetes, and stillbirth have been linked to higher incidences of ischemic strokes and cardiovascular disease at a relatively young age (under 50).
Women with a history of stillbirth have an approximately fivefold increase in stroke risk, higher than risks associated with other complications such as preeclampsia and preterm birth. The strokes related to pregnancy complications often involve large artery disease tied to early atherosclerosis, suggesting that these complications may either reveal underlying vascular vulnerability or contribute causally to vascular damage.
Pregnancy complications provide an early "stress test" for cardiovascular health, indicating the need for closer cardiovascular monitoring and prevention well before typical postmenopausal screening guidelines, possibly starting soon after pregnancy or in early adulthood. Women with histories of pregnancy complications show early signs of cardiovascular risk factors such as elevated blood pressure and markers of future cardiovascular disease as soon as 6 months after pregnancy, particularly after preeclampsia.
For women with severe cardiovascular disease (such as those classified as mWHO Class IV) during pregnancy, pregnancy carries a high risk of adverse cardiac events, death, and long-term morbidity, underscoring the importance of specialized multidisciplinary care and long-term cardiovascular follow-up.
The highest risk occurs in the six weeks after delivery, according to previous research. Those who had previously had a stillbirth were at the highest risk of stroke, estimated to be five times more likely. Complications such as pre-eclampsia and pre-term birth were associated with strokes linked to large artery disease.
Future studies should investigate the effects of lifestyle modification aimed at reducing cardiovascular risk in women with pregnancy complications. Complications during pregnancy, while uncommon in the UK, affect up to 10% of women. Doctors should ask about pregnancy history when assessing stroke risk, according to the study's lead author Dr Frank-Erik de Leeuw.
- The study's findings in women with pregnancy complications suggest an increased risk of ischemic strokes and cardiovascular disease, even in relatively young age, under 50.
- Women with a history of stillbirth have a higher stroke risk, approximately five times more, compared to risks associated with other complications like preeclampsia and preterm birth.
- Future research should focus on the impact of lifestyle modifications on reducing cardiovascular risk in women with pregnancy complications.
- Doctors should take into account pregnancy history when assessing stroke risk, as complications during pregnancy might reveal underlying vascular vulnerability or contribute causally to vascular damage.
