The study examined over a thousand women aged 18 to 49. Of these, 358 had suffered an ischemic stroke. Researchers compared the pregnancy histories of these women with those of 714 women who had not experienced a stroke. The results showed that more than half of the women who had an ischemic stroke had experienced at least one complication during pregnancy. In the group without ischemic stroke, this was one-third.
Women who had experienced a stillbirth were found to be nearly five times more likely to suffer an ischemic stroke. Preeclampsia—characterized by high blood pressure and protein loss through urine—was also clearly linked to an increased risk, as were preterm birth and gestational diabetes. These complications are often associated with vascular damage, such as atherosclerosis.
'Fortunately, the overall risk of stroke remains low', emphasizes neurologist Frank-Erik de Leeuw of Radboudumc. 'But we see that certain pregnancy problems can serve as an early warning. If doctors are aware of this medical history, they can start preventive care earlier.'
Cause
This study does not determine the exact cause of the strokes, but several possible explanations exist. 'Pregnancy places a tremendous strain on the body', explains researcher and first author Esmée Verburgt. 'If complications arise, it may indicate vulnerable blood vessels.' Another possible explanation is that pregnancy itself and the development of the placenta may lead to vascular abnormalities, resulting in atherosclerosis, which could later cause a stroke.
Prevention
The researchers advocate physicians—such as general practitioners and gynecologists—to actively inquire about previous pregnancies. Current guidelines recommend screening women with a history of preeclampsia for cardiovascular disease starting at age 50. De Leeuw: 'This study suggests we might need to start earlier, as there is a clearly elevated risk of cardiovascular disease.' According to the researchers, this can be done easily, for example by measuring blood pressure once a year.
Stroke: recognize the signs
Stroke affects up to one in five people in some high-income countries and nearly one in two in low-income countries. It is the second leading cause of death worldwide. In the Netherlands, approximately 30,000 people have an ischemic stroke and over 50,000 people experience a TIA annually. 6000 people suffer from intracerebral hemorrhage. Signs that may indicate a stroke include a drooping mouth, slurred speech, and sudden weakness or paralysis of an arm. Read our press release on stroke based on a scientific article in The Lancet of Frank-Erik de Leeuw, Nina Hilkens and others.
About the publication
This research was published in Neurology: History of Pregnancy Complications and the Risk of Ischemic Stroke in Young Women. Esmée Verburgt, Nina A. Hilkens, Jamie Inge Verhoeven, [...] Marleen M.H.J. van Gelder, Nel Roeleveld, Ralph R. Scholten, Frank-Erik De Leeuw. DOI: 10.1212/WNL.0000000000214009.
The study used data from two large databases: the ODYSSEY study, which followed young women who had suffered an ischemic stroke, and the PRIDE study, a national cohort study on the health of mothers and children during and after pregnancy.
