Women with pregnancy-associated stroke at higher risk of MI, VTE: JAMA

The cohort study revealed that women with pregnancy-associated stroke had lower risks of overall CV events, ischemic stroke, and death and similar risks of cerebral venous thrombosis and intracerebral haemorrhage compared to non–pregnancy-associated stroke. However, there was a greater risk of acute coronary syndrome with ST-segment elevation and venous thromboembolism.

Previous studies have shown that women with pregnancy-associated stroke might have different risks of stroke recurrence, including during subsequent pregnancies and other CV events due to pregnancy-specific stroke risk factors, such as preeclampsia, gestational hypertension, or gestational diabetes.

Yannick Béjot, University Hospital and Medical School of Dijon, University of Burgundy, Burgundy, France, and colleagues aimed to estimate the rate of cardiovascular hospitalization, stroke recurrence, and death in women with pregnancy-associated stroke versus women with non–pregnancy-associated stroke.

The study comprised all women ages 15 to 49 years in France who were affiliated with the general scheme of French health care insurance (94% of women) and had a first admission for stroke between 2010 to 2018. They were followed up until December 31, 2020, and noted for death, hospitalization for cardiovascular conditions, and stroke recurrence. Data were obtained from the French healthcare database.

The study led to the following findings:

• Among women aged between 15 and 49 between 2010 and 2018 and living in France, 1204 had a pregnancy-associated stroke at a mean age of 31.5 years, and 31 697 had a non–pregnancy-associated stroke at a mean age of 39.6 years.
• Among the 1204 women with a pregnancy-associated stroke, the incidence rate was 11.4 per 1000 person-years, with two recurrent events during a subsequent pregnancy.
• Women with pregnancy-associated stroke had lower risks of ischemic stroke (adjusted HR, 0.53), cardiovascular events (adjusted HR, 0.58), and death (adjusted HR, 0.42) compared with women with non–pregnancy-associated stroke.
• There was no significant difference in the risk of recurrent intracerebral haemorrhage and cerebral venous thrombosis. In contrast, the chances of venous thromboembolism (HR, 2.02) and acute coronary syndrome with ST-segment elevation (HR, 3.93) were increased.

In the study, the recurrence of ischemic stroke, death, and overall long-term cardiovascular outcomes remained lower after pregnancy than in women with non–pregnancy-associated stroke except for myocardial infarction (MI) and venous thromboembolism (VTE).

"These findings indicate that pregnancy-associated risk factors for stroke can disappear after pregnancy and postpartum, decreasing the risk of recurrence," the researchers wrote. "The higher risk of VTE and acute MI after pregnancy-associated stroke compared with non–pregnancy-associated stroke underscores the additional risk associated with pregnancy regarding these events."

Reference:

Béjot Y, Olié V, Lailler G, et al. Comparison of Stroke Recurrence, Cardiovascular Events, and Death Among Patients With Pregnancy-Associated vs Non–Pregnancy-Associated Stroke. JAMA Netw Open. 2023;6(6):e2315235. doi:10.1001/jamanetworkopen.2023.15235