Maternal Complications in Pregnancy: Higher Risks Tied to CVA than TIA, Despite Similar Neonatal Outcomes, finds study
Canada: A recent study has revealed a higher incidence of myriad maternal complications, including postpartum hemorrhage, hypertensive disorders of pregnancy, and death in women diagnosed with a cerebrovascular accident (CVA) before or during pregnancy versus women with a transient ischemic attack (TIA) diagnosis.
The neonatal outcomes were comparable between both groups, stressing the different prognoses of these conditions and the importance of diligent follow-up and care in these patients. The findings were published online in the Archives of Gynecology and Obstetrics on July 15, 2024.
Cerebrovascular accidents, often resulting in significant disability, occur when blood flow to the brain is interrupted, leading to potentially severe complications. In contrast, transient ischemic attacks are characterized by temporary disruptions in blood flow, typically resolving within 24 hours. Understanding how these conditions impact pregnancy is crucial, given that cerebrovascular accidents and transient ischemic attacks are uncommon neurologic events in women of childbearing age.
Against the above background, Uri Amikam, Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada, and colleagues aimed to compare delivery, pregnancy, and neonatal outcomes between women who suffered from a CVA and those who experienced a TIA.
For this purpose, the researchers performed a retrospective population-based cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. The study included all pregnant women who delivered or had a maternal death in the US from 2004 to 2014.
Women diagnosed with a CVA before or during pregnancy were compared to those with a TIA diagnosed either before, during pregnancy, or at the time of delivery. Pregnancy and perinatal outcomes were analyzed between the two groups using multivariate logistic regression to account for potential confounding factors.
The following were the key findings of the study:
· Among 9,096,788 women in the database, 898 met the inclusion criteria.
· Of them, 706 women had a CVA diagnosis, and 192 had a TIA diagnosis.
· Women with a CVA, compared to those with a TIA, had a higher rate of pregnancy-induced hypertension (aOR 3.82); preeclampsia (aOR 2.6), eclampsia (aOR 13.78); postpartum hemorrhage (aOR 4.52), blood transfusion (aOR 5.57), and maternal death (54 versus 0 cases, 7.6% vs. 0%), with comparable neonatal outcomes.
The study not only deepens the understanding of the impacts of cerebrovascular events on pregnancy but also calls for further research to develop effective strategies for managing and supporting affected women throughout their reproductive years. As more women with prior cerebrovascular events seek pregnancy, these insights will be vital for improving maternal and neonatal health outcomes.
Reference:
Amikam, U., Badeghiesh, A., Baghlaf, H. et al. Obstetric and perinatal outcomes in women with cerebrovascular accident vs. transient ischemic attack: an evaluation of a population database. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07627-7
