What are the risk factors for pregnancy-related stroke?
The following characteristics have been linked to an increased risk of having a pregnancy-related stroke:
- African-American race
- Age more than 35 years
- High blood pressure disorders of pregnancy:
- Heart failure
- Heart valve disease
- Heart muscle disease ( cardiomyopathy)
- Blood clotting disorders
- Excessive vomiting during pregnancy
- Caesarean delivery
- Sickle cell disease
- Migraine headaches
Does having a caesarean delivery increase my risk of stroke?
Caesarean delivery is a risk factor for stroke (13 strokes per 100,000 deliveries). This may, in part, be related to there being a higher number of caesarean deliveries among women who have had a stroke when pregnant or who have preeclampsia, which also increases the risk of stroke. Another consideration is that surgery in general results in reduced levels of protein C, an important anticlotting factor when activated, thereby increasing the chances of developing blood clots after surgery.2 In one study from Taiwan, the risk of stroke within a year of delivery was 1.5 to 1.7 times higher among women who had a caesarean delivery compared with women who had vaginal delivery.9
How can I prevent pregnancy-related stroke?
Many factors combine to make stroke more likely to occur during and after pregnancy. Knowing how to prevent them is complicated by the fact that many major risk factors for stroke during pregnancy, such as preeclampsia, are still poorly understood. Much still needs to be done to learn how to identify which women are at higher risk for pregnancy-related stroke, and what can be done to prevent it. For now, the best strategy to minimize your stroke risk is to work with your doctor to address the major risk factors we do know how to control: high blood pressure, diabetes, and heart disease. Women with high blood pressure who are planning to become pregnant should talk to their doctor about proper precautions to take before conceiving, such as controlling their blood pressure and weight.
Women with chronic high blood pressure or preeclampsia can take medication to lower their blood pressure, preventing strokes and seizures. Pregnant women should not take ACE inhibitors or ARBs since they may be harmful to the fetus, but many high blood pressure medications are safe to take during pregnancy. As blood pressure falls in early pregnancy, women with mild or moderate high blood pressure may decrease or stop the use of medications. Women with salt-sensitive high blood pressure who were taking diuretics before conceiving may continue to take them in lower doses during pregnancy.10
Low-dose aspirin is sometimes given throughout pregnancy to women who are at risk for preeclampsia, although there is little evidence of safety, especially during the first trimester, and no evidence of its effect on the risk of stroke or other complications during or after pregnancy. Women who have already had a stroke may wish to discuss with their doctors the possible risks and benefits of taking low-dose aspirin during any subsequent pregnancy.11
If you have other heart disease, make sure you discuss with your doctor the risks associated with pregnancy. With careful planning, many heart conditions can be successfully managed during pregnancy.