Study Background and Disease Burden
Pregnancy is often a time of significant health changes for women, and complications during this period can have long-term health implications. Recent studies have increasingly recognized the importance of maternal health in relation to cardiovascular outcomes later in life. Specifically, pregnancy complications such as hypertensive disorders of pregnancy (HDP), small for gestational age (SGA), preterm birth, gestational diabetes, stillbirth, and miscarriage have been associated with increased risks of ischemic stroke several years later. Ischemic strokes, which result from interrupted blood flow to the brain, are a leading cause of morbidity and mortality worldwide. Understanding the interplay between pregnancy-related complications and the risk of stroke is crucial for developing preventative strategies aimed at young women, typically under the age of 50, who may be unduly affected by these long-term health risks.
Study Design
The recent research by Verburgt et al. included a well-defined population comprising 358 women aged 18 to 49 years with first-ever imaging-proven ischemic stroke, sourced from the Observational Dutch Young Symptomatic StrokE (YSE) study. This cohort was compared to a control group of 714 women from the Pregnancy and Infant Development Study, matched for age at their most recent pregnancy and gravidity. The study meticulously assessed the incidence of pregnancy complications such as HDP, SGA, preterm birth, gestational diabetes, stillbirth, and miscarriage, and quantified their associations with subsequent ischemic stroke occurrences.
Key Findings
The study revealed significant differences in the pregnancy histories between women with ischemic stroke and those without. Notably, women who experienced ischemic stroke at a young age (median maternal age = 28 years [IQR = 24-31]) were significantly more likely to report a history of various pregnancy complications compared to their counterparts without stroke (median maternal age = 29 years [IQR = 26-31]). Specifically, the study observed the following associations:
– **Hypertensive Disorders of Pregnancy (HDP):** Women with a history of HDP showed a heightened risk of ischemic stroke, particularly in cases associated with large artery disease.
– **Small for Gestational Age (SGA):** A significant correlation was established between SGA births and the likelihood of experiencing a stroke.
– **Preterm Birth:** Similar trends were noted, emphasizing that those who had preterm deliveries were at an increased risk of ischemic stroke, often linked to underlying vascular dysfunction.
– **Gestational Diabetes, Miscarriage, and Stillbirth:** These complications also reflected a concerning trend; however, their specific risk contributions require further elucidation.
The research suggested that a substantial portion of the strokes in this demographic could be classified as atherosclerotic, underscoring the need for targeted cardiovascular monitoring in women with such obstetric histories. The findings emphasize the increased stroke risks associated with prior HDP, SGA, and preterm births, particularly for strokes stemming from large artery disease as opposed to unknown origins (cryptogenic stroke).
Expert Commentary
The findings presented by Verburgt et al. add significant weight to the existing literature that suggests a potential predictive value for pregnancy complications in assessing ischemic stroke risk in young women. Experts in the field highlight that while the associations noted in this study are compelling, further research is required to establish causality and to explore potential underlying biological mechanisms. For instance, chronic inflammation and vascular remodeling during pregnancy may predispose women to future vascular events, a hypothesis that needs careful exploration through longitudinal studies.
Another critical aspect brought forward by opinion leaders is the need for healthcare providers to adopt a proactive approach in recognizing these high-risk groups. Early detection and lifestyle modifications, alongside potential pharmacological interventions, might mitigate the increased stroke risk observed in this demographic. Women’s health specialists may need to integrate screening for pregnancy-related complications into routine care algorithms, especially for those with a family history of cardiovascular diseases.
Conclusion
In summary, a history of pregnancy complications appears to serve as a significant marker for future ischemic stroke risk in young women. This study underscores the necessity for heightened vigilance among healthcare professionals about the long-term cardiovascular implications of pregnancy disorders. Future research should focus on enhancing our understanding of the biological mechanisms linking these early life exposures to later-life health outcomes and developing targeted interventions to improve the health trajectories of affected women.
Reference
Verburgt E, Hilkens NA, Verhoeven JI, Schellekens MMI, Ekker MS, Boot EM, van Alebeek ME, Brouwers PJAM, Arntz RM, Van Dijk G, Gons RAR, Van Uden IWM, Den Heijer T, van Tuijl J, de Laat KF, Van Norden AG, Vermeer SE, Van Zagten MS, Van Oostenbrugge RJ, Wermer MJH, Nederkoorn PJ, Kerkhoff H, Rooyer FA, Van Rooij FG, Van Den Wijngaard IR, Tuladhar AM, van Gelder MMHJ, Roeleveld N, Scholten RR, De Leeuw FE. History of Pregnancy Complications and the Risk of Ischemic Stroke in Young Women. Neurology. 2025 Sep 9;105(5):e214009. doi: 10.1212/WNL.0000000000214009. Epub 2025 Aug 6. PMID: 40768689; PMCID: PMC12334341.