Abstract WP167: Pregnancy And Neonatal Outcomes After A Stroke In An Integrated Healthcare System.

Abstract

Background: Stroke in women of childbearing age is not only disabling but also has lifelong consequences for family planning. There are no large studies on maternal and fetal outcomes in patients with a history of stroke. Methods: We retrospectively collected data from January 2004 to December 2021 on women aged 18-50 years, who had a pregnancy following their cerebrovascular event (CVE) using ICD-10 codes to identify the eligible subjects. Demographic data including maternal age, race, gestational age, mode of delivery, associated medical conditions were collected. Results: 219 patients were included in this cohort with a mean age of 29.1±6.2 at the time of CVE, and a median time between CVE and delivery of 34 months (IQR:13-65). 17 (7.8%) had history of factor V Leiden, Protein C deficiency or lupus associated hypercoagulable state. The initial CVE was identified as acute ischemic stroke in 77 (35.2%), transient ischemic attack (TIA) in 64 (29.2%), subarachnoid hemorrhage in 46 (21%), intracerebral hemorrhage in 23 (10.5%), and cerebral venous thrombosis in 9 (4.2%). The maternal adverse events were seen in 38 (17.3%) patients: 29 (13.2%) with HELLP Syndrome/eclampsia/pre-eclampsia, and 9 (4.1%) with recurrent TIA/stroke within 1 year after pregnancy. The rate of maternal adverse events decreased 5 years after the index stroke (Figure 1A). Patients with a history of stroke were at higher risk of having preterm delivery 38 (17.4%) than the general population. 27 (12.3%) of newborn infants had 1min Apgar<7 while 6 (2.7%) had 5 min Apgar<7. The rate of neonatal poor outcomes (preterm birth or Apgar<7) decreased over time (Figure 1B). Conclusion: The rate of maternal and neonatal adverse events are high in the first 5 years after the CVE and begin to decline thereafter.