Mechanisms and outcomes of stroke during pregnancy and the postpartum period

Miller, Eliza C.; Yaghi, Shadi; Boehme, Amelia K; Willey, Joshua Z.; Elkind, Mitchell S.V.; Marshall, Randolph S.

doi:10.1212/cpj.0000000000000214

Cited by 53 publications

(52 citation statements)

References 30 publications

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“…Stroke is also rare in pregnancy and the puerperium, complicating 34 out of 100,000 deliveries [6], with 75% occurring postpartum [7]. The differential diagnosis for pregnancy-associated stroke includes preeclampsia/eclampsia, cardioembolic disease, antiphospholipid syndrome, inherited thrombophilia, and pregnancy-related hypercoagulability [7].…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis for pregnancy-associated stroke includes preeclampsia/eclampsia, cardioembolic disease, antiphospholipid syndrome, inherited thrombophilia, and pregnancy-related hypercoagulability [7]. Other stroke risk factors include migraine headaches, hypertension, diabetes, smoking, advanced maternal age, and African American race [6].…”

Section: Discussionmentioning

confidence: 99%

“…In retrospect, several aspects of this case could have increased the suspicion for malignancy-associated stroke. First, pregnancy-associated stroke in the second trimester is rare, occurring only in 3% of cases [7]. In nonpregnant patients with cancer, malignancy-associated stroke is common, found in 15% of oncology patients at autopsy [8].…”

Section: Discussionmentioning

confidence: 99%

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Pancreatic Cancer in Pregnancy Presenting with Thromboembolic Events: Case Report and Review of the Literature

Wakefield

Masterson

Borges

et al. 2018

Gynecol Obstet Invest

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Stroke and hepatic vein thrombosis are highly associated with neoplasia but are extremely rare events in young, pregnant women. Rare and recurrent thrombotic events in pregnancy increase the suspicion for occult malignancy. We describe the case of a healthy 31-year-old G2P1 who presented with visual changes and dysarthria during pregnancy. Imaging showed cerebral infarcts. Her thrombophilia evaluation was negative. During delivery, she was diagnosed with fulminant Budd-Chiari Syndrome. Hepatic ultrasound suggested malignancy or metastasis, and postpartum CT scan and biopsy confirmed the diagnosis of Stage IV pancreatic cancer. Although rare in pregnancy, a new diagnosis of malignancy should be considered in patients with recurrent unexplained hypercoagulable complications. We propose an evidence-based algorithm for evaluation of occult malignancy in pregnancy based upon this case and review of the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pancreatic Cancer in Pregnancy Presenting with Thromboembolic Events: Case Report and Review of the Literature

Wakefield

Masterson

Borges

et al. 2018

Gynecol Obstet Invest

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“…Several vital organs bear the brunt of this syndrome resulting in cortical blindness, cerebral oedema, haemorrhagic stroke, liver rupture and subarachnoid haemorrhage. [2][3][4][5] Major consequences of these organ damages are furthermore complicated by preeclampsia to a great extent. Elevated liver enzymes and serum bilirubin signify compromised hepatic function whereas decreased platelet count and increased haemolysis indicate increased risk for bleeding disorders for these particular varieties of preeclampsia patients.…”

Section: Introductionmentioning

confidence: 99%

“…If not recognised at early stage, the outcome of this syndrome is grim due to development of neurological complications like strokes or other neurological deficits. [5] Regarding the diagnosis and extent of symptoms, HELLP syndrome has been significantly inconsistent till now. Since Sibai [6] proposed strict criteria for the diagnosis of the "true HELLP syndrome", it has been observed that many women with severe preeclampsia may have laboratory abnormalities such as isolated haemolysis or low platelet count or elevated liver enzymes, without the complete HELLP syndrome.…”

Section: Introductionmentioning

confidence: 99%

Metabolic Derangements as Indicators of Partial Hellp Syndrome

Roy¹,

Dasgupta²

2017

jemds

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Comparison of Stroke Recurrence, Cardiovascular Events, and Death Among Patients With Pregnancy-Associated vs Non–Pregnancy-Associated Stroke

et al. 2023

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ImportanceWomen with pregnancy-associated stroke might have different risks of stroke recurrence, including during subsequent pregnancies, and other cardiovascular events due to pregnancy-specific stroke risk factors, such as gestational hypertension, preeclampsia, or gestational diabetes.ObjectiveTo estimate the rate of stroke recurrence, cardiovascular hospitalization, and death in women with pregnancy-associated stroke compared with women with non–pregnancy-associated stroke.Design, Setting, and ParticipantsThis cohort study included all women aged 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 hospitalization for stroke between January 1, 2010, and December 31, 2018. Women were followed up until December 31, 2020, with the registration of stroke recurrence, hospitalization for cardiovascular conditions, and death. Data were from the French health care database Système National des Données de Santé. Statistical analyses were conducted between December 2021 and September 2022.ExposurePregnancy status at the time of stroke.Main Outcomes and MeasuresPoisson regressions were used to estimate incidence rates of these events with 95% CIs. We used Cox proportional hazards regression models to estimate the hazard ratios (HRs) of each event during the follow-up for women with a pregnancy-associated stroke vs women with a non–pregnancy-associated stroke.ResultsAmong women aged between 15 and 49 years between 2010 and 2018 and living in France, 1204 had a pregnancy-associated stroke at a mean (SD) age of 31.5 (5.8) years, and 31 697 had a non–pregnancy-associated stroke at a mean age of 39.6 (8.2) years. Among the 1204 women with a pregnancy-associated stroke, the incidence rate was 11.4 (95% CI, 9.0-14.3) per 1000 person-years, with 2 recurrent events during a subsequent pregnancy. Compared with women with non–pregnancy-associated stroke, women with pregnancy-associated stroke had lower risks of ischemic stroke (adjusted HR, 0.53; 95% CI, 0.36-0.77), cardiovascular events (adjusted HR, 0.58; 95% CI, 0.49-0.69), and death (adjusted HR, 0.42; 95% CI, 0.22-0.79). In contrast, the risk of recurrent intracerebral hemorrhage and cerebral venous thrombosis did not differ significantly, whereas the risks of venous thromboembolism (HR, 2.02; 95% CI, 1.14-3.58) and acute coronary syndrome with ST-segment elevation (HR, 3.93; 95% CI, 1.10-14.0) were increased.Conclusions and RelevanceIn this cohort study, although the risks of ischemic stroke, overall cardiovascular events, and mortality were lower after a pregnancy-associated stroke than after a non–pregnancy-associated stroke, the risks of venous thromboembolism and acute coronary syndrome with ST-segment elevation were higher. Recurrent stroke during a subsequent pregnancy remained rare.

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Mechanisms and outcomes of stroke during pregnancy and the postpartum period

Cited by 53 publications

References 30 publications

Pancreatic Cancer in Pregnancy Presenting with Thromboembolic Events: Case Report and Review of the Literature

Pancreatic Cancer in Pregnancy Presenting with Thromboembolic Events: Case Report and Review of the Literature

Metabolic Derangements as Indicators of Partial Hellp Syndrome

Comparison of Stroke Recurrence, Cardiovascular Events, and Death Among Patients With Pregnancy-Associated vs Non–Pregnancy-Associated Stroke

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