COMMENTARY

Risk for Intracerebral Hemorrhage in Pregnancy and the Postpartum Period

Mark J. Alberts, MD

Disclosures

June 18, 2019

This transcript has been edited for clarity.

Hello. I'm Dr Mark Alberts, physician and chief of the Ayer Neuroscience Institute, which is part of Hartford HealthCare. I'm reporting to you from the American Academy of Neurology Annual Meeting in Philadelphia. Welcome to this Medscape update.

Great science has been presented at this meeting. I would like to focus on one study that really caught my eye. This was a large study from University of Texas at Houston that included over 3 million deliveries and evaluated the risk for stroke related to pregnancy and delivery.[1]

They found that during the last part of pregnancy—the third trimester and early postpartum, particularly the first month or two—there was a significantly elevated risk for cerebral hemorrhage.

Prior studies have shown an increased risk for stroke during and after pregnancy, but many of those strokes were ischemic strokes. This is one of the few large studies to show an increased risk for cerebral hemorrhage, which is among the worst types of strokes you can have.

What is underneath this increased risk for cerebral hemorrhage? It's really unclear. We know that when it comes to ischemic stroke in pregnancy, clotting factors, increased blood viscosity, eclampsia, and preeclampsia could predispose to ischemic stroke.

What about hemorrhagic stroke? We know that there may be dysfunction of cerebral autoregulation during pregnancy, particularly in the late third trimester and early postpartum period, that could be subserving some of this. Again, eclampsia and preeclampsia can cause issues with blood vessel stability and the structural integrity of the wall, which may increase the risk for hemorrhagic stroke.

This is certainly an area that requires more research and better understanding so that we can more effectively prevent strokes. Strokes at any time are devastating but especially in a woman who is pregnant or just gave birth.

Stay tuned. This is an area of active research, so I hope we can give you updates in the future.

Thank you for your attention. This is Dr Mark Alberts, reporting from the American Academy of Neurology in Philadelphia for Medscape. Thank you.

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