Abstract
This review details the evidence that the risk of stroke is increased in the peripartum and postpartum period rather than the entire 9 months of pregnancy. In women with prior stroke, available evidence suggests that the excess risk of a stroke recurrence in pregnancy is approximately 1% to 2%. Although certain conditions have a particularly strong association with stroke in pregnancy, such as eclampsia, or with the postpartum period, such as cerebral venous thrombosis, the clinical and therapeutic approach to women with stroke during pregnancy should be similar to the approach to stroke in young adults. Strategies for stroke prevention should take into account the competing risks to mother and fetus.
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References and Recommended Reading
Stern BJ: Cerebrovascular disease and pregnancy. In Neurological Disorders of Pregnancy, edn 2, revised. Edited by Goldstein PJ, Stern BJ. Mount Kisco, NY: Futura Publishing; 1994.
Mas JL, Lamy C: Stroke in pregnancy and the puerperium. J Neurol 1998, 245:305–313.
Cross JN, Castro PO, Jennett WB: Cerebral strokes associated with pregnancy and the puerperium. BMJ 1968, 3:214–218.
Wiebers DO, Whisnant JP: The Incidence of stroke among pregnant women in Rochester, Minn, 1955 through 1979. JAMA 1985, 254:3055–3057.
Lidegaard O: Oral contraception and risk of a cerebral thromboembolic attack: results of a case7-control study. BMJ 1993, 306:956–962.
Sharshar T, Lamy C, Mas JL, for the Stroke in Pregnancy Study Group: Incidence and causes of strokes associated with pregnancy and puerperium: a study of public hospitals of Ile de France. Stroke 1995, 26:930–936.
Nencini P, Inzitari D, Baruffi MC, et al.: Incidence of stroke in young adults in Florence, Italy. Stroke 1988, 19:977–981.
Kittner SJ, McCarter RJ, Sherwin RW, et al.: Black-white differences in stroke risk among young adults. Stroke 1993, 24(suppl-I):I13-I15.
Kittner SJ, Stern BJ, Feeser BR, et al.: Pregnancy and the risk of stroke. N Engl J Med 1996, 335:768–774.
Salonen RH, Lichtenstein P, Bellocco R, Petersson S, Cnattingius S: Increased risks of circulatory diseases in the late pregnancy and puerperium. Epidemiology 2001, 12:456–460. National study of Swedish birth cohort quantitating risks of each stroke subtype based on discharge diagnoses. The only study to examine the risk of the immediate peripartum period or to quantitate the risk of subarachnoid hemorrhage.
Lanska DJ, Kryscio RJ: Peripartum stroke and intracranial venous thrombosis in the National Hospital Discharge Survey. Gynecology 1997, 89:413–418.
Lanska DJ, Kryscio RJ: Stroke and intracranial venous thrombosis during pregnancy and puerperium. Neurology 1998, 51:1622–1628.
Lanska DJ, Kryscio RJ: Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke 2000, 31:1274–1282. An administrative database was used to study incidence and risk factors for cerebral venous thrombosis.
Witlin AG, Friedman SA, Egerman RS, Frangieh AY, Sibai BM: Cerebrovascular disorders complicating pregnancy—beyond eclampsia. Am J Obstet Gynecol 1997, 176:1139–1145.
Lamy C, Hamon JB, Coste J, Mas JL: Ischemic stroke in young women: risk of recurrence with subsequent pregnancies. French study Group on Stroke in Pregnancy. Neurology 2000, 55:269–274. Although risk estimates are limited by small numbers, this paper provides the best data for counseling women with prior stroke who wish to become pregnant. Important article using administrative database to study incidence and risk factors for cerebral venous thrombosis.
Brick J: Vanishing cerebrovascular disease of pregnancy. Neurology 1988, 38:804–806.
Garner BF, Burns P, Bunning RD, Laurena R: Acute blood pressure elevation can mimic arteriographic appearance of cerebral vasculitis (a postpartum case with relative hypertension). J Rheumatol 1990, 17:93–97.
Calabrese LH, Furlan AJ, Gragg LA, Ropos TJ: Primary angitis of the central nervous system: diagnostic criteria and clinical approach. Cleveland Clin J Med 1992, 59:293–306.
Geraghty J, Hoch D, Robert M, Vinters H: Fatal puerperal cerebral vasospasm and stroke in young women. Neurology 1991, 41:1145–1147.
Granier I, Garcia E, Geissler A, Boespflug, Gasselin J: Postpartum cerebral angiopathy associated with administration of sumatriptan and dihydroergotamine—a case report. Intensive Care Med 1999, 23:532–534.
Janssens E, Hommel M, Monier-Vehier M, Lecterc Masgent B, Leys D: Postpartum cerebral angiopathy possibly due to bromocriptine therapy. Stroke 1995, 26:128–130.
Einhaupl KM, Villringer A, Meister W, et al.: Heparin treatment in sinus venous thrombosis. Lancet 1991, 338:597–600.
Bousser MG: Cerebral venous thrombosis: nothing, heparin, or local thrombolysis? Stroke 1999, 30:481–483.
Imperiale TF, Stollenwerk-Petrulis A: A meta-analysis of low dose aspirin for the prevention of pregnancy-induced hypertensive disease. JAMA 1991, 266:260–264.
CLASP Collaborative Group, CLASP Coordinating Centre, Radcliffe Infirmary, Oxford: Low dose aspirin in pregnancy and early childhood development: follow up of the Collaborative Low Dose Aspirin Study in Pregnancy. Br J Obstet Gynaecol 1995, 102:861–868.
Bailey DN, Weibert RT, Naylor AJ, Shaw RF: A study of salicylate and caffeine excretion in the breast milk of two nursing mothers. J Anal Toxicol 1982, 6:64–68.
Bond GM, Holloway AM: Anaesthesia and breast-feeding—the effect on mother and infant. Anaesth Intensive Care 1992, 20:426–430.
Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G: Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol 1993, 168:1393–1399.
Oakley CM: Anticoagulation and pregnancy. Br Heart J 1995, 74:107–111.
Ginsberg JS, Greer I, Hirsh J: Use of antithrombotic agents during pregnancy. Chest 2001, 119:122s-131s. Authoritative reference on antithrombotic therapy during pregnancy, emphasizing deep venous thrombosis, but also addressing issues pertinent to stroke.
Chan WS, Anand S, Ginsberg J: Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Inter Med 2000, 160:191–196.
Niclot P, Bousser MG: Cerebral venous thrombosis. Curr Treat Options Neurol 2000, 2:343–352.
Dias MS, Sekhar LN: Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Neurosurgery 1990, 27:855–866.
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Pathan, M., Kittner, S.J. Pregnancy and stroke. Curr Neurol Neurosci Rep 3, 27–31 (2003). https://doi.org/10.1007/s11910-003-0033-x
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DOI: https://doi.org/10.1007/s11910-003-0033-x