Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis of Women’s Health Initiative Study

Qureshi, Adnan I.; Saeed, Omar; Malik, Ahmed; Suri, M. Fareed K.

doi:10.1016/j.ajog.2016.12.004

Cited by 20 publications

(13 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The findings from the Women's Health Initiative show a trend toward increased risk of hemorrhagic stroke in women who had their last pregnancy at age ‡40 years versus before age 40. 79 Preeclampsia, a risk factor for future cardiovascular disease, is also much more common in women of AMA. 79 Israeli women giving birth at age ‡45 years had about 40% lower mortality risk compared with women who gave birth before age 35.…”

Section: Subsequent Health Postpregnancy In Amamentioning

confidence: 99%

“…79 Preeclampsia, a risk factor for future cardiovascular disease, is also much more common in women of AMA. 79 Israeli women giving birth at age ‡45 years had about 40% lower mortality risk compared with women who gave birth before age 35. 80 Further studies are needed to investigate mortality risk in AMA, because factors other than reproductive age may be involved, such as early life stressors and reproduction accelerating aging.…”

Section: Subsequent Health Postpregnancy In Amamentioning

confidence: 99%

See 1 more Smart Citation

Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age

Correa‐de‐Araujo

Yoon

2021

Journal of Women's Health

View full text Add to dashboard Cite

Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ‡35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.

show abstract

Section: Subsequent Health Postpregnancy In Amamentioning

confidence: 99%

Section: Subsequent Health Postpregnancy In Amamentioning

confidence: 99%

Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age

Correa‐de‐Araujo

Yoon

2021

Journal of Women's Health

View full text Add to dashboard Cite

show abstract

“…However, whether pregnancy has a negative effect in the long term on the prognosis of women with CAD remains unclear. Older women embarking on pregnancy have a higher rate of later cardiovascular events,15 suggesting that pregnancy may have an adverse cardiovascular impact.…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal outcomes in women with history of coronary artery disease

Cauldwell

Steer

Klemperer

et al. 2019

Heart

View full text Add to dashboard Cite

BackgroundPregnancy outcomes in women with pre-existing coronary artery disease (CAD) are poorly described. There is a paucity of data therefore on which to base clinical management to counsel women, with regard to both maternal and neonatal outcomes.MethodWe conducted a retrospective multicentre study of women with established CAD delivering at 16 UK specialised cardiac obstetric clinics. We included pregnancies of 24 weeks’ gestation or more, delivered between January 1998 and October 2018. Data were collected on maternal cardiovascular, obstetric and neonatal events.Results79 women who had 92 pregnancies (94 babies including two sets of twins) were identified. 35.9% had body mass index >30% and 24.3% were current smokers. 18/79 (22.8%) had prior diabetes, 27/79 (34.2%) had dyslipidaemia and 21/79 (26.2%) had hypertension. The underlying CAD was due to atherosclerosis in 52/79 (65.8%), spontaneous coronary artery dissection (SCAD) in 11/79 (13.9%), coronary artery spasm in 7/79 (8.9%) and thrombus in 9/79 (11.4%).There were six adverse cardiac events (6.6% event rate), one non-ST elevation myocardial infarction at 23 weeks’ gestation, two SCAD recurrences (one at 26 weeks’ gestation and one at 9 weeks’ postpartum), one symptomatic deterioration in left ventricular function and two women with worsening angina. 14% of women developed pre-eclampsia, 25% delivered preterm and 25% of infants were born small for gestational age.ConclusionWomen with established CAD have relatively low rates of adverse cardiac events in pregnancy. Rates of adverse obstetric and neonatal events are greater, highlighting the importance of multidisciplinary care.

show abstract

“…Higher risk of pregnancyrelated ICH with advanced maternal age is consistent with prior reports, 16,21 and may be attributable to higher prevalence of risk factors, including hypertension and oral anticoagulation use among older women. 22 With more women having children later in life, 23,24 this association could account for the previously reported increased rate of stroke, including hemorrhagic stroke, during pregnancy and the postpartum period. 25 Similarly, the association of pregnancy-related ICH with tobacco use is also consistent with prior reports, 7,16 and with increased ICH risk associated with tobacco use in the general population.…”

Section: Jama Network Open | Neurologymentioning

confidence: 96%

Association of Primary Intracerebral Hemorrhage With Pregnancy and the Postpartum Period

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Intracerebral hemorrhage (ICH) during pregnancy and the postpartum period results in catastrophic maternal outcomes. There is a paucity of population-based estimates of pregnancyrelated ICH risk, including risk during the extended postpartum period. OBJECTIVE To evaluate ICH risk during pregnancy and an extended 24-week postpartum period in a population-level cohort and to determine fetal and maternal outcomes as well as demographic and comorbidity factors associated with ICH during pregnancy and post partum. DESIGN, SETTING, AND PARTICIPANTS This study used a cohort-crossover design in which patients serve as their own controls when no longer exposed (pregnant or post partum). Administrative data were obtained from all hospital admissions for New York, California, and Florida for a 7-to 10-year period. Participants included all women admitted for labor and delivery who were older than 12 years and did not have a prior diagnosis of ICH. Conditional Poisson regression models were used to evaluate ICH risk, and data were reported as rate ratios and 95% CIs. Data analysis was performed from August 2018 to February 2020. EXPOSURES Women were tracked using hospitalization records for the duration of pregnancy (40 weeks), for 24 weeks post partum, and for an additional 64 weeks when no longer exposed. MAIN OUTCOMES AND MEASURES Diagnosis of ICH during both 64-week observation periods was determined using validated International Classification of Diseases, Ninth Revision codes. RESULTS A total of 3 314 945 pregnant women were included (mean [SD] age, 28.17 [6.47] years; 1 451 780 white [43.79%], 474 808 black [14.32%], 246 789 Asian [7.44%], and 835 917 Hispanic [25.22%]). The risk of ICH was significantly higher during the third trimester (2.9 vs 0.7 cases per 100 000 pregnancies; rate ratio, 4.16; 95% CI, 2.52-6.86) and remained elevated during the first 12 weeks post partum (4.4 vs 0.5 cases per 100 000 pregnancies; rate ratio, 9.15; 95% CI, 5.16-16.23).

show abstract

Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis of Women’s Health Initiative Study

Abstract: Women with pregnancy at an advanced age have a higher risk for hemorrhagic stroke in the postmenopausal period.

Cited by 20 publications

References 30 publications

Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age

Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age

Maternal and neonatal outcomes in women with history of coronary artery disease

Association of Primary Intracerebral Hemorrhage With Pregnancy and the Postpartum Period

Contact Info

Product

Resources

About