Anna Richardt, Liisa Verho, Aino Korhonen, Kirsi Rantanen, Hannele Laivuori, Mika Gissler, Minna Tikkanen, Karoliina Aarnio, Petra Ijäs
{"title":"母亲缺血性卒中后后续妊娠的卒中复发与妊娠结局。","authors":"Anna Richardt, Liisa Verho, Aino Korhonen, Kirsi Rantanen, Hannele Laivuori, Mika Gissler, Minna Tikkanen, Karoliina Aarnio, Petra Ijäs","doi":"10.1161/STROKEAHA.125.051488","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Maternal ischemic stroke (IS) might affect the course of subsequent pregnancies. We aimed to study stroke recurrence, other complications, and the implementation of secondary prevention in subsequent pregnancies of women with a prior maternal IS.</p><p><strong>Methods: </strong>Women diagnosed with IS during pregnancy or puerperium in Finland during the years 1987 to 2016, and the data of subsequent pregnancies were collected from the Medical Birth Register and Hospital Discharge Register. Diagnoses were verified from medical records. Three matched controls without a maternal stroke were identified for each case.</p><p><strong>Results: </strong>Data on subsequent pregnancies were available for 90 patients with maternal IS after excluding patients who died within 1 year. Patients with maternal IS less frequently had at least 1 subsequent pregnancy (38.9% versus 51.7%; age-adjusted odds ratio, 0.55 [95% CI, 0.32-0.93]), and more frequently, multiple induced abortions (adjusted odds ratio, 6.24 [95% CI, 1.12-34.88]) than controls. Three women had a recurrent maternal IS or transient ischemic attack (8.6%). Patients with maternal IS more commonly had diabetes during pregnancy (29.1% versus 13.6%; adjusted odds ratio, 2.77 [95% CI, 1.17-6.59]) and hypertensive disorders of pregnancy than controls (12.7% versus 4.5%; adjusted odds ratio, 3.57 [95% CI, 1.02-12.51]). In the first subsequent pregnancy, perinatal deaths were more common in patients with maternal IS compared with controls (5.9% versus 0%; <i>P</i>=0.042). Most women used antithrombotic medication (87.9%) in the first subsequent pregnancy, but this declined in later pregnancies. The use of other secondary preventive medications was uncommon both before and during pregnancy.</p><p><strong>Conclusions: </strong>Although most pregnancies proceed without complications, the subsequent pregnancies of women with a prior maternal IS are high-risk pregnancies that require careful planning and surveillance. They are frequently complicated with diabetes and hypertensive disorders of pregnancy, and the recurrence of IS or transient ischemic attack is notable.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":8.9000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stroke Recurrence and Pregnancy Outcomes in the Subsequent Pregnancies After Maternal Ischemic Stroke.\",\"authors\":\"Anna Richardt, Liisa Verho, Aino Korhonen, Kirsi Rantanen, Hannele Laivuori, Mika Gissler, Minna Tikkanen, Karoliina Aarnio, Petra Ijäs\",\"doi\":\"10.1161/STROKEAHA.125.051488\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Maternal ischemic stroke (IS) might affect the course of subsequent pregnancies. We aimed to study stroke recurrence, other complications, and the implementation of secondary prevention in subsequent pregnancies of women with a prior maternal IS.</p><p><strong>Methods: </strong>Women diagnosed with IS during pregnancy or puerperium in Finland during the years 1987 to 2016, and the data of subsequent pregnancies were collected from the Medical Birth Register and Hospital Discharge Register. Diagnoses were verified from medical records. Three matched controls without a maternal stroke were identified for each case.</p><p><strong>Results: </strong>Data on subsequent pregnancies were available for 90 patients with maternal IS after excluding patients who died within 1 year. Patients with maternal IS less frequently had at least 1 subsequent pregnancy (38.9% versus 51.7%; age-adjusted odds ratio, 0.55 [95% CI, 0.32-0.93]), and more frequently, multiple induced abortions (adjusted odds ratio, 6.24 [95% CI, 1.12-34.88]) than controls. Three women had a recurrent maternal IS or transient ischemic attack (8.6%). Patients with maternal IS more commonly had diabetes during pregnancy (29.1% versus 13.6%; adjusted odds ratio, 2.77 [95% CI, 1.17-6.59]) and hypertensive disorders of pregnancy than controls (12.7% versus 4.5%; adjusted odds ratio, 3.57 [95% CI, 1.02-12.51]). In the first subsequent pregnancy, perinatal deaths were more common in patients with maternal IS compared with controls (5.9% versus 0%; <i>P</i>=0.042). Most women used antithrombotic medication (87.9%) in the first subsequent pregnancy, but this declined in later pregnancies. The use of other secondary preventive medications was uncommon both before and during pregnancy.</p><p><strong>Conclusions: </strong>Although most pregnancies proceed without complications, the subsequent pregnancies of women with a prior maternal IS are high-risk pregnancies that require careful planning and surveillance. They are frequently complicated with diabetes and hypertensive disorders of pregnancy, and the recurrence of IS or transient ischemic attack is notable.</p>\",\"PeriodicalId\":21989,\"journal\":{\"name\":\"Stroke\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":8.9000,\"publicationDate\":\"2025-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Stroke\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/STROKEAHA.125.051488\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/STROKEAHA.125.051488","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Stroke Recurrence and Pregnancy Outcomes in the Subsequent Pregnancies After Maternal Ischemic Stroke.
Background: Maternal ischemic stroke (IS) might affect the course of subsequent pregnancies. We aimed to study stroke recurrence, other complications, and the implementation of secondary prevention in subsequent pregnancies of women with a prior maternal IS.
Methods: Women diagnosed with IS during pregnancy or puerperium in Finland during the years 1987 to 2016, and the data of subsequent pregnancies were collected from the Medical Birth Register and Hospital Discharge Register. Diagnoses were verified from medical records. Three matched controls without a maternal stroke were identified for each case.
Results: Data on subsequent pregnancies were available for 90 patients with maternal IS after excluding patients who died within 1 year. Patients with maternal IS less frequently had at least 1 subsequent pregnancy (38.9% versus 51.7%; age-adjusted odds ratio, 0.55 [95% CI, 0.32-0.93]), and more frequently, multiple induced abortions (adjusted odds ratio, 6.24 [95% CI, 1.12-34.88]) than controls. Three women had a recurrent maternal IS or transient ischemic attack (8.6%). Patients with maternal IS more commonly had diabetes during pregnancy (29.1% versus 13.6%; adjusted odds ratio, 2.77 [95% CI, 1.17-6.59]) and hypertensive disorders of pregnancy than controls (12.7% versus 4.5%; adjusted odds ratio, 3.57 [95% CI, 1.02-12.51]). In the first subsequent pregnancy, perinatal deaths were more common in patients with maternal IS compared with controls (5.9% versus 0%; P=0.042). Most women used antithrombotic medication (87.9%) in the first subsequent pregnancy, but this declined in later pregnancies. The use of other secondary preventive medications was uncommon both before and during pregnancy.
Conclusions: Although most pregnancies proceed without complications, the subsequent pregnancies of women with a prior maternal IS are high-risk pregnancies that require careful planning and surveillance. They are frequently complicated with diabetes and hypertensive disorders of pregnancy, and the recurrence of IS or transient ischemic attack is notable.
期刊介绍：
Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery.
The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists.
Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.
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