Thursday, Feb. 2, 2023 (American Heart Association News) — Women with pregnancy-related health problems are more likely to have a stroke earlier in life than women with uncomplicated pregnancies. The risk of developing it is high, and the risk increases with each complicated pregnancy. , suggests a new study.
The findings, which will be presented at the American Stroke Association’s International Stroke Conference in Dallas on February 8, show that women who have had two or more complicated pregnancies are more likely to be pregnant than those without serious complications. showed that the risk of stroke doubles by the age of 45.
“It’s really young,” said lead study author Eliza Miller, Ph.D., an assistant professor of neurology at Columbia University in New York City. Even a small stroke can have a big impact on their lives.”
Findings are considered preliminary until full results are published in peer-reviewed journals.
Miller was inspired to do this research after seeing women in their 40s and 50s having strokes in the clinic. Many of the women had poor pregnancy outcomes and high blood pressure problems. “I thought they were too young to have this type of stroke,” Miller said. She wondered if there was something about hypertension-related pregnancy outcomes that was accelerating the risk of stroke in women.
Previous studies have established associations between adverse pregnancy outcomes such as pre-eclampsia or APO and women’s risk of future heart disease and stroke. However, there has been little data showing how pre-eclampsia and other pregnancy-related complications affect women when they have their first stroke.
In this study, researchers used data from Finland’s national health registry on 130,764 women who gave birth after 1969, when the birth registry was established. The analysis included 285,545 live births. The researchers defined APO as gestational hypertension, pre-eclampsia, eclampsia, a pregnancy that is affected if the placenta separates from the uterine wall, or if the baby reaches full term or is born with low birth weight.
Overall, nearly 15% (19,442) of women experienced one adverse pregnancy outcome and nearly 3% (3,639) experienced multiple APOs. Women who had APO had higher rates of obesity, high blood pressure, high cholesterol, heart disease, and migraines compared to women who had no complications in their pregnancy.
Stroke occurred in 5.4% (7,006) of the women in the study. A stroke is counted if it’s been more than a year since the baby was born. The study included larger strokes caused by blood clots or hemorrhages in the brain and smaller strokes known as transient ischemic attacks (TIAs).
Among women with no history of APO, the median age at first stroke was 59 years. A woman with one of her APOs had her first stroke at an average age of 55 years. Women who had multiple complicated pregnancies had a stroke at an average age of 51 years. A woman who had multiple unfavorable pregnancies had twice her risk of developing a stroke before age 45 as did a woman younger than 45. For women without APO.
Medical professionals who supervise women’s pregnancies should immediately refer those with complications, especially recurrent complications, for stroke prevention, Miller said.
“We can really change this,” she said. , fall into the group for which aggressive primary prevention should be undertaken.”
Ideally, stroke prevention should begin earlier, even before a woman becomes pregnant, said Nisha Parikh, Ph.D., an associate professor of clinical medicine at the University of California, San Francisco.
“We are beginning to realize that it is increasingly important to take cardiovascular prophylaxis in the context of a woman’s life course,” she said. .”
Parikh, who was not involved in the study, chaired the writing committee for the 2021 American Heart Association Scientific Statement on Adverse Pregnancy Outcomes and Cardiovascular Disease. This statement emphasizes the need for greater prevention efforts, such as adopting a heart-healthy diet and increased physical activity, for women with a history of APO to reduce these risks during routine preconception care. encouraged to deal with
She said the new study is powerful because it looked at the added risk of multiple pregnancies with poor outcomes. “Most women have repeat pregnancies,” she said. “Also, if she’s had one bad pregnancy outcome, she’s more likely to have another.”
For women known to be at higher risk, there are steps to reduce those risks, Miller said. For example, taking low-dose aspirin helps prevent preeclampsia, a complication associated with high blood pressure, and also increases a woman’s risk of dying during pregnancy.
Health professionals can also encourage women with APO to take other measures, such as taking statins to lower cholesterol levels, quitting smoking and improving sleep habits, she said. said. “There are many things you can do to reduce your risk of stroke on an individual level.”
Parikh said health care professionals should regularly ask women about their pregnancy history to identify those who may benefit from previous stroke prevention efforts.
“It’s easy to ask about adverse pregnancy outcomes, but as clinicians we tend not to ask these questions,” Parikh said. “Everyone should ask. This is learning history. No cost, just be careful.”
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Laura Williamson American Heart Association News