Stroke Recurrence and Pregnancy Outcomes in the Subsequent Pregnancies After Maternal Ischemic Stroke

BACKGROUND: Maternal ischemic stroke (IS) might affect the course of subsequent pregnancies. We aimed to study stroke recurrence, other complications, and the implementation of secondary prevention in subsequent pregnancies of women with a prior maternal IS.

METHODS: Women diagnosed with IS during pregnancy or puerperium in Finland during the years 1987 to 2016, and the data of subsequent pregnancies were collected from the Medical Birth Register and Hospital Discharge Register. Diagnoses were verified from medical records. Three matched controls without a maternal stroke were identified for each case.

RESULTS: Data on subsequent pregnancies were available for 90 patients with maternal IS after excluding patients who died within 1 year. Patients with maternal IS less frequently had at least 1 subsequent pregnancy (38.9% versus 51.7%; age-adjusted odds ratio, 0.55 [95% CI, 0.32-0.93]), and more frequently, multiple induced abortions (adjusted odds ratio, 6.24 [95% CI, 1.12-34.88]) than controls. Three women had a recurrent maternal IS or transient ischemic attack (8.6%). Patients with maternal IS more commonly had diabetes during pregnancy (29.1% versus 13.6%; adjusted odds ratio, 2.77 [95% CI, 1.17-6.59]) and hypertensive disorders of pregnancy than controls (12.7% versus 4.5%; adjusted odds ratio, 3.57 [95% CI, 1.02-12.51]). In the first subsequent pregnancy, perinatal deaths were more common in patients with maternal IS compared with controls (5.9% versus 0%; P=0.042). Most women used antithrombotic medication (87.9%) in the first subsequent pregnancy, but this declined in later pregnancies. The use of other secondary preventive medications was uncommon both before and during pregnancy.

CONCLUSIONS: Although most pregnancies proceed without complications, the subsequent pregnancies of women with a prior maternal IS are high-risk pregnancies that require careful planning and surveillance. They are frequently complicated with diabetes and hypertensive disorders of pregnancy, and the recurrence of IS or transient ischemic attack is notable.