Stroke risk is increased in women who experience any of five common pregnancy complications, according to UTHealth Houston research

Women who experienced any of five common pregnancy complications, including gestational diabetes and preeclampsia, faced a higher risk of stroke even decades after giving birth, according to a new study by researchers at UTHealth Houston.

The findings, led by Casey Crump, MD, PhD, MPH, first author of the study and professor in the Department of Family & Community Medicine at McGovern Medical School at UTHealth Houston, were published today in the European Heart Journal.

Along with gestational diabetes and preeclampsia, adverse complications linked to a long-term increased risk of stroke were other hypertensive disorders, preterm delivery, and babies who were small for gestational age. The study cohort included 2.2 million women with a singleton delivery in Sweden from 1973 to 2015. Follow-up for stroke was done for 46 years through 2018. In the study group, 30% experienced an adverse pregnancy outcome and 1.6% were diagnosed with stroke. The findings were only partially explained by shared familial factors, according to the researchers. Stroke is the third leading cause of death in women and kills more women than men, according to the American Stroke Association (ASA). 

The risk of stroke was nearly doubled for women with high blood pressure (but not preeclampsia) or diabetes during pregnancy. Preterm delivery resulted in a 40% higher risk of stroke. The higher risk for preeclampsia was 36%, and for women with babies born small for their gestational age, 26%. 

The findings, Crump said, can enable providers to work with patients who have experienced one of these complications to reduce their risk of stroke over their lifetime. According to the ASA, high blood pressure is the leading preventable cause of stroke.

“Good medical care before conception and during pregnancy is crucial for helping to prevent these adverse pregnancy outcomes. However, when we observe one of these complications during a woman’s pregnancy, we know she has higher long term risk,” said Crump, who is also a professor of epidemiology at UTHealth Houston School of Public Health. “That is a critical time to begin implementing aggressive reduction of other risk factors.”

Crump said that women at higher risk should avoid tobacco use, and control their blood pressure, cholesterol, and blood sugar. Maintaining a healthy weight and regular physical activity can also reduce the risk of stroke. Regular appointments with a physician are extremely important.

The alarm needs to be sounded in the health care world for providers just as much as for patients, according to Crump. “Many women who have adverse pregnancies are lost to follow-up, and there may be a lack of awareness - from the woman herself and her provider - that she is at increased risk of stroke and requires early monitoring and intervention,” said Crump, who is director of the Center for Population Health Sciences at UTHealth Houston.

Crump said women should be transitioned quickly from obstetric to primary care. “These women need good long term care with prevention and reduction of other risk factors,” Crump said. “These complications should be recognized as long term risk factors for stroke and other cardiovascular disease across the life course. Hopefully this will allow earlier intervention to improve women’s long term health.”

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