Stroke during pregnancy and postpartum

doi:10.3969/j.issn.1672-6731.2021.11.014

Abstract

Abstract:

Stroke during pregnancy and postpartum, though uncommon, can significantly affect the lives of women and their families. However, the current research on the subsequent pregnancy and health status of women, with a history of pregnancy-related stroke, is limited. To provide reference for the prevention and treatment of stroke during pregnancy and postpartum, this article reviews the epidemiology, risk factors, pathophysiological mechanism, and treatment of pregnancy-related stroke.

Key words: Stroke, Pregnancy, Review

摘要：

妊娠相关脑卒中临床虽不常见，但可显著影响女性健康及家庭生活。目前关于存在妊娠相关脑卒中病史的女性后继妊娠和健康状况的研究有限。本文系统综述妊娠相关脑卒中的流行病学、危险因素、病理生理学机制和治疗方案，以期为妊娠相关脑卒中预防与治疗的进一步研究提供方向。

关键词: 卒中, 妊娠, 综述

LI Yu-jian, ZHENG Jun, LI Hao. Stroke during pregnancy and postpartum[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(11): 1007-1012.

李育健, 郑峻, 李浩. 妊娠相关脑卒中[J]. 中国现代神经疾病杂志, 2021, 21(11): 1007-1012.

/ / Recommend / Download Citations

URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2021.11.014

https://journal11.magtechjournal.com/cjcnn/EN/Y2021/V21/I11/1007

References

[1] Liu SL, Chan WS, Joel RG, Michael KS, Laura A, Nadialie A, Liz D, Jane E, Joseph KS, Julian L, Lily L, Sarah M, Aideen M, Phil M, Reginald S, Heather S, Prakesh S, Mike VDF. Stroke and cerebrovascular disease in pregnancy:incidence, temporal trends, and risk factors[J]. Stroke, 2019, 50:13-20.
[2] GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017:a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2018, 392:1736-1788.
[3] Yandrapalli S, Nabors C, Goyal A, Aronow WS, Frishman WH. Modifiable risk factors in young adults with first myocardial infarction[J]. J Am Coll Cardiol, 2019, 73:573-584.
[4] Opaskar A, Massaquoi R, Sila C. Stroke in pregnancy[J]. Handb Clin Neurol, 2021, 177:283-293.
[5] Karjalainen L, Tikkanen M, Rantanen K, Laivuori H, Gissler M, Ijäs P. Pregnancy-associated stroke-a systematic review of subsequent pregnancies and maternal health[J]. BMC Pregnancy Childbirth, 2019, 19:187.
[6] Camargo EC, Feske SK, Singhal AB. Stroke in pregnancy:an update[J]. Neurol Clin, 2019, 37:131-148.
[7] Ban L, Sprigg N, Abdul Sultan A, Nelson-Piercy C, Bath PM, Ludvigsson JF, Stephansson O, Tata LJ. Incidence of first stroke in pregnant and nonpregnant women of childbearing age:a population-based cohort study from England[J]. J Am Heart Assoc, 2017, 6:e004601.
[8] Kuklina EV, Tong X, Bansil P, George MG, Callaghan WM. Trends in pregnancy hospitalizations that included a stroke in the United States from 1994 to 2007:reasons for concern[J]? Stroke, 2011, 42:2564-2570.
[9] Swartz RH, Cayley ML, Foley N, Ladhani NNN, Leffert L, Bushnell C, McClure JA, Lindsay MP. The incidence of pregnancy -related stroke:a systematic review and meta-analysis[J]. Int J Stroke, 2017, 12:687-697.
[10] Yan XX, Shao B. Retrospective analysis of 314 cases with stroke related to pregnancy in mainland China[J]. Zhongguo Lin Chuang Shen Jing Ke Xue, 2012, 20:665-667.[颜晓晓, 邵蓓. 中国大陆妊娠相关性脑卒中314例临床资料分析[J]. 中国临床神经科学, 2012, 20:665-667.]
[11] Zhao J, Hu FY. Analysis of related risk factors for stroke during pregnancy and puerperium[J]. Zhongguo Yao Wu Yu Lin Chuang, 2017, 17:882-884.[赵静, 胡风云. 妊娠及产褥期合并脑卒中的相关危险因素分析[J]. 中国药物与临床, 2017, 17:882-884.]
[12] van Alebeek ME, de Heus R, Tuladhar AM, de Leeuw FE. Pregnancy and ischemic stroke:a practical guide to management[J]. Curr Opin Neurol, 2018, 31:44-51.
[13] Miller EC, Leffert L. Stroke in pregnancy:a focused update[J]. Anesth Analg, 2020, 130:1085-1096.
[14] Elgendy IY, Gad MM, Mahmoud AN, Keeley EC, Pepine CJ. Acute stroke during pregnancy and puerperium[J]. J Am Coll Cardiol, 2020, 75:180-190.
[15] Lappin JM, Darke S, Duflou J, Kaye S, Farrell M. Fatal stroke in pregnancy and the puerperium[J]. Stroke, 2018, 49:3050-3053.
[16] Salehi Omran S, Leppert MH. Are strokes declining among pregnant women with hypertensive disorders of pregnancy[J]? J Am Heart Assoc, 2020, 9:e017917.
[17] Cheng CA, Lee JT, Lin HC, Lin HC, Chung CH, Lin FH, Tsao CH, Wu YF, Chien WC, Chiu HW. Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk[J]. QJM, 2017, 110:355-360.
[18] Miller EC, Gatollari HJ, Too G, Boehme AK, Leffert L, Elkind MS, Willey JZ. Risk of pregnancy-associated stroke across age groups in New York State[J]. JAMA Neurol, 2016, 73:1461-1467.
[19] Brown DW, Dueker N, Jamieson DJ, Cole JW, Wozniak MA, Stern BJ, Giles WH, Kittner SJ. Preeclampsia and the risk of ischemic stroke among young women:results from the Stroke Prevention in Young Women Study[J]. Stroke, 2006, 37:1055-1059.
[20] Tang CH, Wu CS, Lee TH, Hung ST, Yang CY, Lee CH, Chu PH. Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan[J]. Stroke, 2009, 40:1162-1168.
[21] Limaye K, Patel A, Dave M, Kenmuir C, Lahoti S, Jadhav AP, Samaniego EA, Ortega -Gutièrrez S, Torner J, Hasan D, Derdeyn CP, Jovin T, Adams HP Jr, Leira EC. Secular increases in spontaneous subarachnoid hemorrhage during pregnancy:a nationwide sample analysis[J]. J Stroke Cerebrovasc Dis, 2019, 28:1141-1148.
[22] Zhu D, Zhao P, Lv N, Li Q, Fang Y, Li Z, Zhang H, Duan G, Hong B, Xu Y, Liu J, Huang Q. Rupture risk of cerebral arteriovenous malformations during pregnancy and puerperium:a single-center experience and pooled data analysis[J]. World Neurosurg, 2018, 111:e308-315.
[23] Miller EC, Sundheim KM, Willey JZ, Boehme AK, Agalliu D, Marshall RS. The impact of pregnancy on hemorrhagic stroke in young women[J]. Cerebrovasc Dis, 2018, 46:10-15.
[24] Joseph NK, Kumar S, Brown RD Jr, Lanzino G, Flemming KD. Influence of pregnancy on hemorrhage risk in women with cerebral and spinal cavernous malformations[J]. Stroke, 2021, 52:434-441.
[25] Ngene NC, Moodley J. Physiology of blood pressure relevant to managing hypertension in pregnancy[J]. J Matern Fetal Neonatal Med, 2019, 32:1368-1377.
[26] Dłuski D, Mierzyński R, Poniedziałek-Czajkowska E, Leszczyńska-Gorzelak B. Adverse pregnancy outcomes and inherited thrombophilia[J]. J Perinat Med, 2018, 46:411-417.
[27] Kristoffersen AH, Petersen PH, Røraas T, Sandberg S. Estimates of within-subject biological variation of protein C, antithrombin, protein S free, protein S activity, and activated protein C resistance in pregnant women[J]. Clin Chem, 2017, 63:898-907.
[28] ACOG practice bulletin No. 207:thrombocytopenia in pregnancy[J]. Obstet Gynecol, 2019, 133:e181-193.
[29] Garg RK, Kumar N, Malhotra HS. Posterior reversible encephalopathy syndrome in eclampsia[J]. Neurol India, 2018, 66:1316-1323.
[30] Ladhani NNN, Swartz RH, Foley N, Nerenberg K, Smith EE, Gubitz G, Dowlatshahi D, Potts J, Ray JG, Barrett J, Bushnell C, Bal S, Chan WS, Chari R, El Amrani M, Gandhi S, Hill MD, James A, Jeerakathil T, Jin A, Kirton A, Lanthier S, Lausman A, Leffert LR, Mandzia J, Menon B, Pikula A, Poppe A, Saposnik G, Sharma M, Bhogal S, Smitko E, Lindsay MP. Canadian Stroke Best Practice Consensus Statement:acute stroke management during pregnancy[J]. Int J Stroke, 2018, 13:743-758.
[31] Dinehart E, Leon Guerrero C, Pham A, Chandra S, Petersen SM, Bathgate S, Ahmadzia H. Extending the window for thrombolysis for treatment of acute ischaemic stroke during pregnancy:a review[J]. BJOG, 2021, 128:516-520.
[32] Landais A, Chaumont H, Dellis R. Thrombolytic therapy of acute ischemic stroke during early pregnancy[J]. J Stroke Cerebrovasc Dis, 2018, 27:e20-23.
[33] Watanabe TT, Ichijo M, Kamata T. Uneventful pregnancy and delivery after thrombolysis plus thrombectomy for acute ischemic stroke:case study and literature review[J]. J Stroke Cerebrovasc Dis, 2019, 28:70-75.
[34] Ritchie J, Lokman M, Panikkar J. Thrombolysis for stroke in pregnancy at 39 weeks gestation with a subsequent normal delivery[J]. BMJ Case Rep, 2015:bcr2015209563.
[35] Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49:e46-110.
[36] Swartz RH, Ladhani NNN, Foley N, Nerenberg K, Bal S, Barrett J, Bushnell C, Chan WS, Chari R, Dowlatshahi D, Amrani ME, Gandhi S, Gubitz G, Hill MD, James A, Jeerakathil T, Jin A, Kirton A, Lanthier S, Lausman A, Leffert LR, Mandzia J, Menon B, Pikula A, Poppe A, Potts J, Ray J, Saposnik G, Sharma M, Smith EE, Bhogal S, Smitko E, Lindsay MP; Heart and Stroke Foundation Canadian Stroke Best Practice Advisory Committees. Canadian stroke best practice consensus statement:secondary stroke prevention during pregnancy[J]. Int J Stroke, 2018, 13:406-419.
[37] Shah SS, Snelling BM, Brunet MC, Sur S, McCarthy DJ, Stein A, Khandelwal P, Starke RM, Peterson EC. Peterson, Transradial mechanical thrombectomy for proximal middle cerebral artery occlusion in a first trimester pregnancy:case report and literature review[J]. World Neurosurg, 2018, 120:415-419.
[38] Szuchy Kristiansen E, Holm Vestergaard H, Modrau B, Oppel LM. Acute ischemic stroke in late pregnancy treated with intravenous thrombolysis and endovascular therapy[J]. Case Rep Neurol, 2019, 11:41-46.
[39] Blythe R, Ismail A, Naqvi A. Mechanical thrombectomy for acute ischemic stroke in pregnancy[J]. J Stroke Cerebrovasc Dis, 2019, 28:e75-76.
[40] Tse GH, Balian V, Charalampatou P, Maliakal P, Nayak S, Dyde R, Nagaraja S. Foetal radiation exposure caused by mechanical thrombectomy in large-vessel ischaemic stroke in pregnancy[J]. Neuroradiology, 2019, 61:443-449.
[41] Kular S, Ram R, Balian V, Tse G, Coley S, Jivraj S, Nagaraja S. Mechanical thrombectomy for acute stroke in pregnancy[J]. Neuroradiol J, 2020, 33:134-139.
[42] Katsuragi S, Yoshimatsu J, Tanaka H, Tanaka K, Nii M, Miyoshi T, Neki R, Toyoda K, Nagatsuka K, Takahashi JC, Fukuda K, Hamano E, Satow T, Miyamoto S, Iihara K, Ikeda T. Management of pregnancy complicated with intracranial arteriovenous malformation[J]. J Obstet Gynaecol Res, 2018, 44:673-680.
[43] Sappenfield EC, Jha RT, Agazzi S, Ros S. Cerebral arteriovenous malformation rupture in pregnancy[J]. BMJ Case Rep, 2019, 12:e225811.
[44] Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, Al-Shahi Salman R, Vicaut E, Young WL, Houdart E, Cordonnier C, Stefani MA, Hartmann A, von Kummer R, Biondi A, Berkefeld J, Klijn CJ, Harkness K, Libman R, Barreau X, Moskowitz AJ; international ARUBA investigators. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA):a multicentre, non-blinded, randomised trial[J]. Lancet, 2014, 383:614-621.
[45] Toossi S, Moheet AM. Intracerebral hemorrhage in women:a review with special attention to pregnancy and the post-partum period[J]. Neurocrit Care, 2019, 31:390-398.
[46] Can A, Du R. Neurosurgical issues in pregnancy[J]. Semin Neurol, 2017, 37:689-693.
[47] Ascanio LC, Maragkos GA, Young BC, Boone MD, Kasper EM. Spontaneous intracranial hemorrhage in pregnancy:a systematic review of the literature[J]. Neurocrit Care, 2019, 30:5-15.
[48] Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S; International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive disorders of pregnancy:ISSHP classification, diagnosis, and management recommendations for international practice[J]. Hypertension, 2018, 72:24-43.
[49] Mahendra V, Clark SL, Suresh MS. Neuropathophysiology of preeclampsia and eclampsia:a review of cerebral hemodynamic principles in hypertensive disorders of pregnancy[J]. Pregnancy Hypertens, 2021, 23:104-111.
[50] Tada M. Reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES)[J]. No Shinkei Geka, 2021, 49:342-348.
[51] Ma HL, Xu ZP, Zhao X, Xia ZY. Analysis of clinical features of pregnancy or postpartum combined with reversible posterior leukoencephalopathy syndrome[J]. Lin Chuang Shen Jing Bing Xue Za Zhi, 2018, 31:103-106.[马红玲, 许志平, 赵鑫, 夏章勇. 妊娠期及产后合并可逆性后部白质脑病综合征的临床特点分析[J]. 临床神经病学杂志, 2018, 31:103-106.]
[52] Roth J, Deck G. Neurovascular disorders in pregnancy:a review[J]. Obstet Med, 2019, 12:164-167.
[53] Zeitouni D, Parish JM, Smith M, Stetler WR, Bernard JD. Reversible cerebral vasoconstriction syndrome successfully treated by intrathecal nicardipine[J]. Clin Neurol Neurosurg, 2021, 206:106705.
[54] Wang HR, Peng JF, Yuan ZX. Analysis of clinical and imaging features of 17 pregnant patients complicated with PRES[J]. Zhongguo Ji Ceng Yi Yao, 2020, 27:685-689.[王虹壬, 彭剑峰,袁子雄. 妊娠相关后部可逆性脑病综合征17例的临床及影像学表现分析[J]. 中国基层医药, 2020, 27:685-689.]
[55] Parikh NS, Schweitzer AD, Young RJ, Giambrone AE, Lyo J, Karimi S, Knobel A, Gupta A, Navi BB. Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome[J]. J Neurol Sci, 2017, 380:11-15.
[56] Singhal AB, Topcuoglu MA. Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome[J]. Neurology, 2017, 88:228-236.

Please choose a citation manager

Content to export