The Adaptation of the Cerebral Circulation to Pregnancy: <i>Mechanisms and Consequences</i>

Cipolla, Marilyn J.

doi:10.1038/jcbfm.2012.210

Cited by 74 publications

(77 citation statements)

References 120 publications

(160 reference statements)

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“…Cerebrovascular changes are thought to result from hormones that increase during pregnancy, such as estrogen, progesterone, and vascular endothelial growth factor (36). Other reported factors that may potentiate aneurysm progression during pregnancy include high levels of relaxin and increased wall tension from intraparenchymal artery hypoplasia (6,51).…”

Section: █ Introductionmentioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

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It has been estimated that 1.8% of women of childbearing age (16 to 44 years) develop intracranial aneurysms, however the incidence of unruptured intracranial aneurysms during pregnancy is not well established in the literature (25). Rupture of intracranial aneurysms occurs in the range of 1 to 10 per 100,000 pregnancies (1, 33). Case fatality from subarachnoid hemorrhage during pregnancy is reported as high as 83%, but outcomes have improved with better medical care (10, 12). Cerebrovascular management of aneurysms during pregnancy is complicated by the nature of maternal hemodynamics and their intimate relationship to the developing child. Given the dependence of the fetus on its mother, and the importance of a stable environment during fetal development, risk reduction from an intracranial aneurysm must clearly focus on both the mother and the child (39,40,42). Whether these aneurysms █ INTRODUCTIONAlthough intracranial aneurysms are uncommon during pregnancy, normal hemodynamic changes in pregnant women may increase vascular stress and the risk of aneurysm formation, progression and rupture (35,44,47). Systemically, maternal adaptations to pregnancy include increases in cardiac output (CO) and plasma volume (PV), and a redistribution of the CO between various organs (43). Cerebrovascular changes are thought to result from hormones that increase during pregnancy, such as estrogen, progesterone, and vascular endothelial growth factor (36). Other reported factors that may potentiate aneurysm progression during pregnancy include high levels of relaxin and increased wall tension from intraparenchymal artery hypoplasia (6, 51).Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms during pregnancy have not been clearly defined. The objective of this review is to describe the treatment options for pregnant women with intracranial aneurysms, and to report the maternal and fetal outcomes associated with different treatment strategies. A search of the literature was conducted using the PubMed database for the period January 1991 through June 2015. Aneurysm characteristics and management, pregnancy management, and maternal and fetal outcomes were evaluated. The most recent search was performed in June 2015. In total, 50 aneurysms (44 patients) were evaluated. Rupture was confirmed upon imaging in 36 aneurysms (72%), and most aneurysms ruptured during the third trimester (77.8%). Coil embolization was associated with a lower complication rate than clipping in patients with ruptured aneurysms (9.5% vs 23.1%). For patients with unruptured aneurysms, surgical management was associated with 31.9% fewer complications compared to no treatment. Most patients underwent Cesarean delivery (84%), and a combined neurosurgical-obstetrical procedure was used for 8 patients with ruptured aneurysms near term. Adverse outcomes were reported in 11.9% of children. Treatment of intracranial aneurysms during pregnancy is sa...

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Section: █ Introductionmentioning

confidence: 99%

The management of intracranial aneurysms during pregnancy: a systematic review

Barbarite

Hussain

Dellarole

et al. 2015

Turkish Neurosurgery

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“…La cefalea es el síntoma más asociado a la inminencia de eclampsia; nosotros la encontramos en 87,9% de los casos; otras series reportan 45 a 80% (12) . La alta asociación se explica dentro del contexto de la PRES por el edema cerebral como fenómeno fisiopatológico básico; este es producido por la alteración de la permeabilidad de la BHE en el contexto de la preeclampsia (17,18) . Las manifestaciones visuales y auditivas mostraron frecuencias concordantes con otros estudios (12) (27,2% y 12,1%); estas son producidas por la estimulación anormal de grupos neuronales en áreas occipitales y temporales, zonas preferentemente afectadas por edema en los casos de PRES (16)(17)(18) .…”

Section: Discussionunclassified

Epidemiología y manifestaciones neurológicas asociadas a eclampsia en un hospital de referencia del Perú. Serie de casos

Paredes

Moya

Espinoza

et al. 2018

Rev peru ginecol obstet.

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Los ‘síntomas premonitorios’ de la eclampsia se pueden ver englobados como verdaderos síntomas de afectación cerebral dentro del síndrome de leucoencefalopatía posterior reversible, y la eclampsia como un síntoma severo. Objetivo. Revisar las características epidemiológicas de los casos con eclampsia, enfatizando el análisis de las manifestaciones neurológicas asociadas, en un hospital nacional. Diseño. Serie de casos. Institución. Hospital Nacional Daniel A. Carrión (HNDAC), Lima, Perú. Pacientes. Mujeres con eclampsia. Metodología. Estudio de todas las pacientes con eclampsia en un periodo de 5 años y 6 meses. Se excluyó aquellas con eclampsia extrainstitucional o con datos insuficientes. Principales medidas de resultados. Características generales, síntomas asociados, complicaciones y valores laboratoriales en pacientes eclámpticas. Resultados. Se halló 39 casos. La incidencia fue 0,19% del total de gestantes. La edad media fue 21 años, 75,8% fueron primíparas, 44,4% por debajo de las 34 semanas y en 69,7% ocurrió antes del parto; 51,5% tuvo presión arterial mayor a 160/110 mmHg y 12,1% no presentó hipertensión arterial; 93,9% tuvo síntomas, siendo los más frecuentes cefalea (87,9%), alteraciones visuales (27,2%) y auditivas (12,1%). Hubo dos casos de pacientes con cefalea y presión arterial normal, y 2 casos sin sintomatología. Las complicaciones fueron trastorno de sensorio, desprendimiento prematuro de placenta (15,2%), síndrome HELLP (15,2%) e HTA de difícil control (39,4%). No hubo casos de mortalidad materno perinatal. Conclusiones. La sintomatología neurológica que antecede a la eclampsia en la gestante con preeclampsia es muy variable y su correlación con la severidad de la hipertensión arterial materna no es constante.

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“…Major effects of pregnancy on cerebral endothelial and microcirculation have been described, including increased vascular permeability (28). VEGF is not only increased in circulating blood during pregnancy, but is also up-regulated in cerebral veins (29).…”

Section: Discussionmentioning

confidence: 99%

Multiparity improves outcomes after cerebral ischemia in female mice despite features of increased metabovascular risk

Ritzel

Patel

Spychala

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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Females show a varying degree of ischemic sensitivity throughout their lifespan, which is not fully explained by hormonal or genetic factors. Epidemiological data suggest that sex-specific life experiences such as pregnancy increase stroke risk. This work evaluated the role of parity on stroke outcome. Age-matched virgin (i.e., nulliparous) and multiparous mice were subjected to 60 min of reversible middle cerebral artery occlusion and evaluated for infarct volume, behavioral recovery, and inflammation. Using an established mating paradigm, fetal microchimeric cells present in maternal mice were also tracked after parturition and stroke. Parity was associated with sedentary behavior, weight gain, and higher triglyceride and cholesterol levels. The multiparous brain exhibited features of immune suppression, with dampened baseline microglial activity. After acute stroke, multiparous mice had smaller infarcts, less glial activation, and less behavioral impairment in the critical recovery window of 72 h. Behavioral recovery was significantly better in multiparous females compared with nulliparous mice 1 mo after stroke. This recovery was accompanied by an increase in poststroke angiogenesis that was correlated with improved performance on sensorimotor and cognitive tests. Multiparous mice had higher levels of VEGF, both at baseline and after stroke. GFP + fetal cells were detected in the blood and migrated to areas of tissue injury where they adopted endothelial morphology 30 d after injury. Reproductive experience has profound and complex effects on neurovascular health and disease. Inclusion of female mice with reproductive experience in preclinical studies may better reflect the life-long patterning of ischemic stroke risk in women.sex differences | multiparity | microglia | ischemic stroke | microchimerism N early 800,000 people in the United States experience a new or recurrent stroke each year, and 55,000 more women than men are affected by stroke (1). Stroke is a sexually dimorphic disease impacted by genetics, hormones, and the environment (2). According to CDC data, 85% of women in the United States have given birth by age 40, whereas the number of lifetime pregnancies per woman varies by race and socioeconomic status. Therefore, child-bearing women represent a significant proportion of the female population, including those at risk for stroke. Moreover, this suggests that a large proportion of the elderly female populationwho is at highest risk for stroke-may be differentially at risk. Epidemiological data suggest that increasing parity is associated with higher risk of cardiovascular disease (CVD) and stroke and late-life vascular comorbidities, including carotid atherosclerosis (3, 4). However, recent reports suggest that parity has a significant protective effect against CVD mortality (5). The effect of parity on outcome following ischemic stroke is yet unresolved.Pregnancy induces profound acute and long-term physiological changes in the body that influence future vascular health through hormonally med...

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The Adaptation of the Cerebral Circulation to Pregnancy: Mechanisms and Consequences

Cited by 74 publications

References 120 publications

The management of intracranial aneurysms during pregnancy: a systematic review

The management of intracranial aneurysms during pregnancy: a systematic review

Epidemiología y manifestaciones neurológicas asociadas a eclampsia en un hospital de referencia del Perú. Serie de casos

Multiparity improves outcomes after cerebral ischemia in female mice despite features of increased metabovascular risk

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