By Matthew E. Fink, MD
Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, New York Presbyterian/Weill Cornell Medical College
SOURCE: Hung SK, Lee MS, Lin HY, et al. Impact of hypertensive disorders of pregnancy on the risk of stroke stratified by subtypes and follow-up time. Stroke 2022;53:338-344.
Hypertensive disorders of pregnancy include chronic hypertension, chronic hypertension with preeclampsia, preeclampsia/eclampsia, and gestational hypertension. The pathogenesis of these disorders during pregnancy is not fully understood and is multifactorial. It may be related to insulin resistance and/or placental ischemia.
It has been established that women who have hypertension during pregnancy from any cause, compared to those without a history of hypertension, have an increased risk for subsequent stroke. Investigators in this study from Taiwan looked at the differences between the four major types of hypertensive disorders and the relative risks of subsequent stroke in women.
All women affected by any type of hypertension during pregnancy had an increased risk of stroke with an adjusted hazard ratio of 1.71. For ischemic stroke, the hazard ratio was 1.60 and for hemorrhagic stroke, the hazard ratio was 2.98. Both were highly statistically significant findings. Ten to 15 years after childbirth, the overall stroke risk was more than two times the risk for women who did not have hypertension associated with their pregnancy. Ischemic stroke risk reached its peak one to three years after childbirth, while hemorrhagic stroke risk increased to a peak at 10 to 15 years after childbirth. The greatest risk was in patients with chronic hypertension and superimposed preeclampsia.
The authors concluded that hypertensive disorders of pregnancy increased the risk of future stroke and this risk persists for many years following pregnancy. Aggressive intervention of hypertension is strongly suggested for these patients.
