Preexisting Cerebrovascular Disease in Pregnancy: a Case Series on Pregnancy Outcomes (S3.004)

Abstract

<h3>Objective:</h3> To characterize adverse pregnancy outcomes (APO) in patients with preexisting cerebrovascular disease (CVD). <h3>Background:</h3> Detailed data are lacking regarding APO in pregnant patients with CVD, limiting neurologists’ ability to counsel patients. <h3>Design/Methods:</h3> We reviewed medical records of 35 patients with CVD evaluated in a neuro-obstetrics subspecialty clinic embedded within a high risk maternal-fetal medicine practice between August 2019 and December 2021. Patients were referred for neurological evaluation during or prior to pregnancy. We described subsequent maternal and fetal APO, including hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), pre term birth (PTB), fetal growth restriction (FGR), and small for gestational age infant (SGA), as well as delivery mode, postpartum readmissions and recurrent acute CVD. <h3>Results:</h3> A total of 35 patients were included (6 TIA, 14 ischemic stroke, 1 subarachnoid hemorrhage, 1 intracerebral hemorrhage, 5 cerebral venous thrombosis, 3 unruptured aneurysm, 2 arteriovenous malformation, 1 cervical artery dissection, 2 reversible cerebral vasoconstriction syndrome [RCVS]). Average age at delivery was 33 years, and most patients (91%) had vascular risk factors including obesity (23%), chronic hypertension (20%), diabetes mellitus (11%), history of prior APO (26%), and migraine (57%). All patients with prior TIA, ischemic stroke, or cerebral venous thrombosis received antithrombotics during pregnancy. Overall, APO occurred in 44% of pregnancies, and included PTB (28%), HDP (19%), GDM (14%), FGR (8%), and SGA (8%). Cesarean deliveries occurred in 42% of pregnancies, all for obstetric indications. Two patients were readmitted postpartum, one for neurological symptoms (headache) with normal brain imaging, and one for an obstetrical complication. One patient experienced recurrent postpartum CVD (RCVS), without readmission. <h3>Conclusions:</h3> In patients with CVD history, APO were common but recurrent acute CVD was rare. Patients with prior CVD may be at high risk for APO due to underlying vascular risk factors rather than specific CVD diagnosis. <b>Disclosure:</b> Ms. Wyckoff has nothing to disclose. Dr. Mammadli has nothing to disclose. Dr. Booker has nothing to disclose. Dr. D’Alton has a non-compensated relationship as a Advisory Board with Merck for Mothers that is relevant to AAN interests or activities. Dr. LaSala has nothing to disclose. Stephanie Purisch has nothing to disclose. Prof. Valeri has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for McLean Hospital. Prof. Valeri has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA. The institution of Prof. Valeri has received research support from National Institute of Health. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edwards Scientific. Dr. Willey has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for RECARDIO. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Uptodate. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Review chapter author, MKSAP 16-20 with American College of Physicians. Dr. Miller has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Miller has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Argionis and Associates LLC. The institution of Dr. Miller has received research support from National Institutes of Health.