Stroke in Pregnancy

Christina Mijalski Sells, MD, MPH; Steven K. Feske, MD

Disclosures

Semin Neurol. 2017;37(6):669-678. 

In This Article

Abstract and Introduction

Abstract

Pregnancy and the postpartum period confer an increased risk of stroke. The risk appears to be increased for all strokes during the puerperium and for hemorrhagic strokes during pregnancy. During pregnancy, physiologic systems are under increased stress to accommodate the growing fetus, which results in substantial hemodynamic, cardiovascular, hematologic, immunologic, and structural connective tissue changes that account for much of this increased risk. In addition, preeclampsia–eclampsia has major effects on the vascular system, and this disorder, unique to pregnancy, is another major contributor to this risk. The common independent vascular risk factors for stroke, such as hypertension, diabetes, hyperlipidemia, and smoking, may also be present to contribute to the risks conferred by pregnancy. Though uncommon, stroke during pregnancy and in the postpartum period causes substantial morbidity and mortality in affected women, and it poses a significant risk to the fetus. This review will discuss the epidemiology of pregnancy-associated stroke, specific risk factors and mechanisms, clinical presentation and management, and future directions.

Introduction

Though uncommon, pregnancy-associated strokes are the commonest cause of serious long-term disability after pregnancy. Thrombolytic and endovascular therapies shown to be effective in non-pregnant patients should offer pregnant women comparably effective therapies to optimize outcomes. This paper reviews the epidemiology of pregnancy-associated stroke, risk factors, causes, clinical presentation, and management in this vulnerable population.

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