Adverse Pregnancy Outcomes and Stroke Risk

A history of Adverse Pregnancy Outcomes (APOs) is linked to an increased risk of future illness, including stroke. Few large population-based surveys in the United States contained information on APOs.

APOs were shown to be independently related to midlife stroke in the following study using nationally representative survey data from the United States. Women with APOs have an increased risk of having a stroke in their forties, necessitating specific preventative interventions.

The findings of this study were published in the Journal of Women's Health.

This study was conducted by Eliza C. Miller and team with the hypothesis that women in the United States with a self-reported history of APOs had an elevated risk of stroke before the age of 60. They claimed that the link between APOs and stroke is mediated in part by hypertension. Furthermore, the variance of these connections was evaluated in terms of race/ethnicity, income, and education.

The Population Assessment of Tobacco and Health research is a nationally representative survey of 45,971 people in the United States. This cross-sectional study comprised female respondents aged 50 and older who reported a pregnancy history during the 2013–2014 baseline survey. A history of 1 APO, including preterm delivery, poor birth weight, preeclampsia, placental abruption, and stillbirth, was the major exposure. The key outcomes were:

• A stroke before the age of 60
• A stroke at any age

The researchers utilized weighted logistic regression models to determine the odds ratios (OR) and 95% confidence intervals (CI) for the link between APO and stroke, after controlling for age, race/ethnicity, socioeconomic status, parity, and vascular risk factors.

Key Findings

• One APO was reported by 15% of stroke-free individuals.
• 39% of women who had a stroke before the age of 60 had one APO; 25% of women who had a stroke at any age had one APO.
• Women with APOs had a higher risk of stroke before the age of 60, even after controlling for confounders.
• After adjusting for variables, the link of APOs with stroke at any age was not significant.

Conclusion

In conclusion, a self-reported history of APOs was independently related to a more than twofold elevated risk of stroke in midlife in this cross-sectional analysis of women in a nationally representative longitudinal survey of U.S. respondents. The findings imply that doctors caring for obstetric patients can play an important role in identifying young women who should be targeted for intensive therapies focused on primary stroke prevention. The involvement of interdisciplinary postpartum clinics and "cardio-obstetrics" has emerged as a potential technique for improving women's cardiovascular health.

Reference

Eliza C. Miller et al, Women with Adverse Pregnancy Outcomes Have Higher Odds of Midlife Stroke: The Population Assessment of Tobacco and Health Study, Journal of Women's Health (2021). DOI: 10.1089/jwh.2021.0184