How is stroke prevented during pregnancy?

Updated: Aug 20, 2019
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

All women may decrease their risk of stroke by avoiding smoking, by maintaining a healthy body mass index, by avoiding excess alcohol use, by avoiding use of all illegal drugs, and by having their blood pressure checked periodically to detect hypertension. If they are at particular risk for diabetes or elevated cholesterol levels, periodic checks by their primary healthcare provider may be indicated. If hypertension, diabetes, or hypercholesterolemia is diagnosed, meticulous treatment lowers the risk of stroke.

Women with known cerebrovascular disease who are pregnant or plan to become pregnant may take steps to maximize the safety of their pregnancy. If they have previously experienced a cerebral infarction, its cause should have been or should be determined, preferably before the pregnancy occurs, so that appropriate measures can be instituted to minimize the risk of recurrence.

In patients with a known cerebral aneurysm, clipping or coiling should be performed, if possible. Consider cesarean delivery. In patients with a known AVM, the lesion should be resected or embolized. The preferred mode of delivery has not been established.

Opinions differ regarding the best approach to treating pregnant women with hypercoagulable states (thrombophilia). Some authors reserve anticoagulant treatment for those with severe thrombophilias by considering the specific etiology and past clinical symptoms, particularly those noted during previous pregnancies. Patients who previously took warfarin because of recurrent venous thrombotic events must be switched to heparin or a heparinoid before conceiving; this anticoagulant regimen should be maintained throughout the pregnancy.

Some authorities add low-dose aspirin to manage relatively severe thrombophilias. Decisions regarding treatment of mild or moderate thrombophilias must be individualized; some authors reserve the use of anticoagulation for the peripartum period.


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