Long-Term Recovery, Morbidity, and Mortality After Maternal Ischemic Stroke

BACKGROUND AND OBJECTIVES: The long-term prognosis after maternal ischemic stroke (IS) remains understudied. The objectives were to examine if mortality and long-term morbidity are more frequent in women with prior maternal IS compared with women without a pregnancy-related stroke and to assess recovery in maternal IS patients based on functional outcomes and vocational status. METHODS: In this retrospective nationwide cohort study, maternal IS patients in Finland during years 1987-2016 were identified from national healthcare registers and verified from patient records. Three pregnant controls without a pregnancy-related stroke were selected for each case and matched by delivery year, age, parity, and geographical area. Deaths were acquired from the Causes-Of-Death Register until 2022. Morbidities (cardiovascular diseases and depression) were collected from Hospital Discharge Register and vocational status from Statistics Finland until 2016 for those who survived ≥1 year after stroke. Functional outcomes by modified Rankin scale (mRS) were estimated from patient records. RESULTS: There were 97 women with maternal IS, of whom 92 survived ≥1 year after stroke, and 265 matched controls (median age 30.6 years at index delivery in both groups). The median follow-up time was 17.4 years for mortality and 11.6 years for morbidity and vocational status. The overall mortality was higher in maternal IS patients than controls (8.3% vs 1.8%, age-adjusted odds ratio [aOR] 4.96, 95% CI 1.58-15.60) but did not differ significantly after the first year. There were 5 (5.6%) recurrent strokes in maternal IS patients. Patients had more frequently major cardiovascular events (6.7% vs 0%, p < 0.001), cardiac diseases (aOR 8.57, 95% CI 2.22-33.08), and depression (aOR 3.92, 95% CI 1.86-8.24) than controls. Of the patients who survived until the end of follow-up, 92.1% had good functional outcomes (mRS 0-2). Still, employment was rarer (aOR 0.55, 95% CI 0.32-0.94) and retirement (aOR 4.55, 95% CI 2.03-10.17) more common in maternal IS patients than controls. DISCUSSION: Maternal IS patients had a significant cardiovascular burden and were retired more often than controls at the end of follow-up, although most patients had good functional outcomes. Optimizing long-term prognosis in these young patients necessitates comprehensive management of vascular risk factors and targeted rehabilitation strategies to address residual neurologic deficits.