Key result
Adverse pregnancy outcomes increased the risk of future stroke compared with no adverse outcomes (HR 1.3; 95% CI 1.2-1.4 for 1 APO, and HR 1.4; 95% CI 1.2-1.7 for recurrent APO).
Why the study?
Adverse pregnancy outcomes contribute to higher maternal cerebrovascular risk, but longitudinal data incorporating adverse pregnancy outcome and stroke timing are lacking.
Do adverse pregnancy outcomes increase the risk of future stroke in women who gave birth?
Cohort (n=144,306)
Yes
Do adverse pregnancy outcomes increase the risk of future stroke in women who gave birth?
Adverse pregnancy outcomes are associated with a significantly increased risk and earlier onset of stroke in women, highlighting the need for early cardiovascular risk assessment in this population.
May support earlier stroke risk assessment after APO; extends observational associations but leaves causal inference and intervention effects open.
BACKGROUND: Adverse pregnancy outcomes (APO) contribute to higher risk of maternal cerebrovascular disease, but longitudinal data that include APO and stroke timing are lacking. We hypothesized that APO are associated with younger age at first stroke, with a stronger relationship in those with >1 pregnancy with APO. METHODS: We analyzed longitudinal Finnish nationwide health registry data from the FinnGen Study. We included women who gave birth after 1969 when the hospital discharge registry was established. We defined APO as a pregnancy affected by gestational hypertension, preeclampsia, eclampsia, preterm birth, small for gestational age infant, or placental abruption. We defined stroke as first hospital admission for ischemic stroke or nontraumatic intracerebral or subarachnoid hemorrhage, excluding stroke during pregnancy or within 1 year postpartum. We used Kaplan-Meier survival curves and multivariable-adjusted Cox and generalized linear models to assess the relationship between APO and future stroke. RESULTS: We included 144 306 women with a total of 316 789 births in the analysis sample, of whom 17.9% had at least 1 pregnancy with an APO and 2.9% experienced an APO in ≥2 pregnancies. Women with APO had more comorbidities including obesity, hypertension, heart disease, and migraine. Median age at first stroke was 58.3 years in those with no APO, 54.8 years in those with 1 APO, and 51.6 years in those with recurrent APO. In models adjusted for sociodemographic characteristics and stroke risk factors, risk of stroke was greater in women with 1 APO (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.4]) and recurrent APO (adjusted hazard ratio, 1.4 [95% CI, 1.2-1.7]) compared with those with no APO. Women with recurrent APO had more than twice the stroke risk before age 45 (adjusted odds ratio, 2.1 [95% CI, 1.5-3.1]) compared with those without APO. CONCLUSIONS: Women who experience APO have earlier onset of cerebrovascular disease, with the earliest onset in those with more than 1 affected pregnancy.
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Miller et al. (2023) conducted a cohort in Stroke (n=144,306). Adverse pregnancy outcomes vs. No adverse pregnancy outcomes was evaluated on First hospital admission for ischemic stroke or nontraumatic intracerebral or subarachnoid hemorrhage (HR 1.3, 95% CI 1.2-1.4). Adverse pregnancy outcomes increased the risk of future stroke compared with no adverse outcomes (HR 1.3; 95% CI 1.2-1.4 for 1 APO, and HR 1.4; 95% CI 1.2-1.7 for recurrent APO).
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