Pregnancy-Related Stroke Recurrence at a Regional Referral Center [17H

Abstract

INTRODUCTION: To evaluate the risk of perinatal stroke recurrence for women with a history of stroke. METHODS: This is a retrospective cohort study from 2004 to 2014 of pregnant women with a history of stroke attending Thomas Jefferson University Hospital, a regional perinatal and neurosurgical referral center. Using ICD9 codes, pregnancies with a history of stroke were identified. Strokes were stratified into 3 major groups as defined by the American Stroke Association: ischemic, hemorrhagic, and transient ischemic attack (TIA). The primary outcome was pregnancy-relate stroke recurrence. RESULTS: Forty-eight pregnancies in 24 women with a history of stroke were identified. Thirty-one (64.6%) pregnancies had a history of ischemic stroke, 11 (22.9%) had a history of TIA and 6 (12.5%) had a history of hemorrhagic stroke. Antithrombotic treatment, with either aspirin or heparin, was used in 23 (47.9%) pregnancies. Of the 24 women, 1 (4.2%) had stroke recurrence prior to pregnancy compared to one out of 48 pregnancies (2.1%) that occurred 3 days postpartum while not on antithrombotic treatment. Thirty-eight (79.2%) pregnancies resulted in a live birth, 8 (16.7%) resulted in a miscarriage and 2 (4.2%) were ectopic pregnancies. The cesarean section rate for women with a history of hemorrhagic strokes was 100% compared to 25% and 50% for a history of ischemic strokes or TIA, respectively (P<.05). CONCLUSION: Women with a history of stroke appear to have a low risk of stroke recurrence in pregnancy. This study is helpful for informed decision-making regarding future fertility and pregnancy management.