Recent studies have established a connection between adverse pregnancy outcomes and an elevated risk of stroke in women, particularly at a younger age. This finding draws attention to the health implications associated with the prevalence of APOs and their possible long-term effects.
Understanding Adverse Pregnancy Outcomes
Adverse pregnancy outcomes (APOs) encompass various complications that can occur during pregnancy and the postpartum period, affecting the mother or the child. These include conditions like preeclampsia, gestational hypertension, gestational diabetes, pre-term delivery, delivery of a small-for-gestational-age infant, and recurrent miscarriage. In the United States, approximately 20% of pregnancies are affected by APOs, a rate that is reportedly increasing.
Despite advancements in medical care reducing maternal and fetal mortality rates globally, APOs remain a major health concern. According to UNICEF and WHO, the global maternal mortality ratio decreased by 34% from 2000 to 2020, yet the prevalence of APOs continues to be a challenge.
Increased Stroke Risk Linked to APOs
The Smidt Heart Institute at Cedars-Sinai hospital conducted research revealing that women who have adverse pregnancy outcomes are at an increased risk of stroke, particularly if they have multiple pregnancies affected by APOs. Analyzing data from the FinnGen study, which included 316,789 births from 144,306 women who gave birth after 1969, the study found that women with more than two APO-affected pregnancies had a doubled risk of experiencing a stroke before the age of 45. The median age for the first stroke occurrence was lower for women with two or more APO-affected pregnancies, at 51.6 years, compared to 58.3 years for those with uncomplicated pregnancies.
It’s important to note that just as the maternal mortality rate disproportionately affects communities of color, particularly Black women (at a rate of almost three times that of non-Hispanic white women), the risk of APOs is heightened for Black and Hispanic populations, as well as for those experiencing poverty.
Despite these findings, the overall risk of stroke during pregnancy and postpartum remains relatively low, estimated at about 30 strokes per 100,000 deliveries. However, women with certain pre-existing conditions, such as chronic hypertension, heart conditions, or genetic predispositions to blood clots, may have a higher risk. Even with these risk factors, strokes during pregnancy are still considered a rare occurrence in the United States.
Preventive Measures and Management
To mitigate the risk of stroke in women who have experienced APOs, several precautionary steps are recommended by Dr. Shlee S. Song, MD, director of Comprehensive Stroke Center and Telestroke Program at Cedars-Sinai:
Health data monitoring: Dr. Song’s first recommendation is that women should feel empowered to collect their own health data by monitoring their blood pressure and sharing their recorded readings during their medical appointments.
Hyperextension of the neck: Women and men should also avoid hyperextending their neck. Because the neck has critical blood vessels that are near the bone, Song says they can be injured if too much force or quick twisting motions are applied.
Women on hormone treatments: Another preventive strategy is for women on hormone treatment to be cautious not to increase clotting risk by smoking or getting dehydrated.
Staying hydrated: “To decrease clot risk and dehydration, limit alcohol to one glass or serving per day and if having a second, on the occasion, hydrate with water in between,” said Song. “And, when flying—which can cause dehydration or prohibit movement—wear compression stockings and move and stretch your legs whenever you can.”
Conclusion
The FinnGen study's findings underscore the link between APOs and an increased risk of stroke in women, particularly at a younger age. This risk escalates with the number of adverse pregnancy events. While the overall risk of stroke during and after pregnancy is low, it is higher in women with certain medical conditions.
Preventive strategies, including regular medical monitoring, lifestyle changes, and careful management of hormone treatments, are crucial in reducing this risk. These findings emphasize the need for healthcare professionals to recognize the long-term effects of pregnancy-related complications and advocate for preventive care.
Sources
This article was originally published in Certainty News: www.certaintynews.com/article/adverse-pregnancy-outcomes-linked-to-increased-stroke-risk-in-women
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