Maternal Stroke: an Update

Abstract

Purpose of the review: Maternal morbidity and mortality is rising in the United States, and maternal stroke is a major contributor. Here, we review the epidemiology, risk factors and current recommendations for diagnosis and acute treatment of ischemic and hemorrhagic stroke during pregnancy and postpartum, focusing on recent evidence. Recent findings:The incidence of maternal stroke has risen in recent years, possibly due to increasing rates of hypertensive disorders of pregnancy. The risk of maternal stroke is highest in the peripartum and early postpartum period. Preeclampsia is highly associated with reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome, and is also associated with long-term increased risk of stroke and vascular dementia. Hypertensive disorders of pregnancy, migraine, and infections are risk factors for maternal stroke. Limited data suggest that thrombolytics and endovascular reperfusion therapy are safe and effective in pregnant women with ischemic stroke, but few data are available regarding safety of thrombolytics in the postpartum period. New consensus guidelines are now available to assist with management of ischemic and hemorrhagic stroke in pregnancy.Summary: Many gaps remain in our understanding of maternal stroke. While risk factors have been identified, there are no prediction tools to help identify which women might be at highest risk for postpartum stroke and require closer monitoring. The risk of recurrent maternal stroke has not been adequately quantified, limiting clinicians' ability to counsel patients. The complex pathophysiology of preeclampsia and its effects on the cerebral vasculature require further targeted study. An increased focus on the prevention, recognition, and optimal treatment of maternal stroke will be critical to reducing maternal morbidity and mortality.

Preconception Care to Reduce the Risks of Overweight and Obesity in Women of Reproductive Age: An Integrative Review

“…Metabolic processes (e.g., basal metabolic rate, protein usage and storage, triglyceride synthesis, hemodynamic changes) become altered during pregnancy to provide an optimal supply of glucose and protein to mothers and fetuses [ 1 ]. These alterations may extend to the 4th trimester (12 weeks post-delivery) or later in life with increases in the risks for complications, such as maternal stroke or delivery of macrosomic infants [ 9 ]. A continuum of care from preconception to the 4th trimester for women who are overweight or obese is essential [ 10 , 11 ].…”

Gender differences in ischemic stroke intra-hospital mortality: a systematic review

“…However, another risk factor for female subjects is the peripartum period and early postpartum period. 20,21 In fact, it is called maternal stroke. 21 During these periods, the risk for ischemic stroke increase.…”

“…20,21 In fact, it is called maternal stroke. 21 During these periods, the risk for ischemic stroke increase. 20 Conversely, it has been reported that lower levels of education, a lower income, and higher area deprivation were associated with increased risk of stroke among both men and women equally.…”

Deficiency in CD4 T Cells Leads to Enhanced Postpartum Internal Carotid Artery Vasoconstriction in Mice: The Role of Nitric Oxide

“…Recent clinical studies demonstrate a significantly elevated risk for cerebral ischemia and stroke in the PP period ( Kittner et al, 1996 ; Skidmore et al, 2001 ; Simon et al, 2015 ). Several stroke risk factors were identified, including hypertensive disorders of pregnancy, older age, infections, migraine and pre-pregnancy cardiovascular disease ( Evans et al, 2011 ; Hovsepian et al, 2014 ; Leffert et al, 2015 ; Cunningham and LaMarca, 2018 ; Zambrano and Miller, 2019 ).…”