Pregnancy Complications and Outcome in Women with a History of Cerebrovascular Events

Pregnancy induces a hypercoagulable state, heightening the risk of thromboembolic events, particularly for women with prothrombotic tendencies or a history of thromboembolism. Although anticoagulant treatment may improve outcomes for women with a prior stroke and thrombophilic disorders, the risk of recurrent thromboembolic events during subsequent pregnancies remains unclear. This study aims to assess pregnancy outcomes and the risk of recurrence in women with a history of stroke. This retrospective study analyzed pregnancy outcomes of women with a history of cerebrovascular events who delivered at Sheba Medical Center between 2005 and 2023. Data included cerebrovascular events, pregnancy outcomes, and obstetric complications. Comprehensive thrombophilia screening was performed. Patients were treated with low-molecular-weight heparin (LMWH) or low-dose aspirin (LDA). A control group without cerebrovascular events matched for maternal age, delivery timing, and plurality was used for comparison. A total of 107 women were included, 49 pregnancies with a previous cerebrovascular thrombosis, and 58 with a previous transient cerebrovascular ischemic attack. About 50.4% of the study group women had prothrombotic conditions. Cesarean section rates were higher in the study group (44%) versus controls (14%, p < 0.001). Preterm delivery rates were also higher (11 vs. 1.9%, p = 0.0057). Other obstetric complications were similar. A subgroup analysis of women without thrombophilia still showed increased risks for cesarean section and preterm delivery. Two women experienced recurrent thromboembolic events during pregnancy, both without maternal thrombophilia. Higher cesarean and preterm delivery rates were observed, regardless of thrombophilia status. The recurrence rate of thromboembolic events was low (2.2%), highlighting that with appropriate prenatal care and tailored prophylactic treatment, women with a history of cerebrovascular events may achieve favorable pregnancy outcomes.