An exhaustive new Dutch study has discovered that women who experience specific pregnancy complications face much higher odds of suffering an ischemic stroke before they turn 50.
The research, published in the journal Neurology, is among the first to connect these problems to overall stroke risk as well as specific types of stroke. The paper also offers new insight into possible shared mechanisms between pregnancy health and later cardiovascular disease.
“Fortunately, the overall risk of stroke remains low,” co-author and neurologist Frank-Erik de Leeuw of Radboud University Medical Center said in a statement. ‘But we see that certain pregnancy problems can serve as an early warning. If doctors are aware of this medical history, they can start preventive care earlier.”
A Younger Woman’s Stroke Risk
While strokes remain more common in older adults, ischemic stroke strikes more young women than men. Researchers have long suspected that sex-specific factors, including pregnancy complications, might help explain this mystery. Multiple studies have already tied these complications to cardiovascular events later in life, but their role in stroke before age 50 wasn’t obvious. Until now.
Lead author Esmée Verburgt of Radboud University Medical Center and colleagues set out to map that connection.
“Pregnancy places a tremendous strain on the body,” explains researcher and first author Verburgt added. “If complications arise, it may indicate vulnerable blood vessels.”
Two Cohorts, One Picture
The team sifted through reams of data from a pair of vast, still-ongoing studies. The Observational Dutch Young Symptomatic StrokE studY (ODYSSEY) followed 358 women between 18 and 49 who’d suffered a first-ever ischemic stroke.
The researchers then compared those pregnancy histories to 714 similarly aged women from the Pregnancy and Infant Development Study (PRIDE), who hadn’t experienced a stroke.
On average, strokes occurred 16 years after a woman’s first pregnancy.
The Numbers Tell a Clear Story
A little more than half of the women (50.8%) who experienced a stroke also endured at least one pregnancy complication. That’s compared to 30.7% in the control group.
After adjusting for maternal age at first pregnancy, the odds ratios told a haunting tale:
- Preeclampsia translated into a stroke risk that was four times higher than average.
- Hypertensive disorders of pregnancy (HDP) also meant four times the stroke danger.
- Small-for-gestational-age (SGA) births led to 2.8 times higher odds.
- Preterm births, similarly, spawned 2.7 times higher stroke odds.
- Gestational diabetes worked out to stroke rates that were 2.6 times higher.
- Stillbirths, as if they weren’t tragic enough, also meant that the surviving mothers faced odds of a stroke that were nearly five times higher than average.
- Miscarriages, on the other hand, resulted in a much more modest stroke risk – at 1.3 times higher.
Even when the researchers turned their gaze to first-time pregnancies, they noticed that the pattern persisted.
Stroke Subtypes Offer Clues
Notably, the researchers didn’t stop at finding out which mothers went on to have strokes. They also documented what kinds of strokes.
Using the TOAST classification system, researchers found that women whose strokes were likely caused by large artery disease seemed to be more likely to have had HDP, SGA births, or preterm deliveries.
This connection – the authors contend – suggests that pregnancy complications and certain strokes might share underlying vascular issues, such as endothelial dysfunction or abnormal placental blood vessel development.
“Pregnancy complications could be an early warning sign of cardiovascular disease in women,” the authors wrote. “Alternatively, they may actively promote atherosclerosis, contributing to later stroke risk.”
Even so, the link wasn’t exclusive. More than 40% of women with cryptogenic strokes also had a history of pregnancy complications, hinting that hidden atherosclerotic processes might be at work.
Why It Matters
Most of the universally accepted clinical guidelines recommend cardiovascular risk monitoring for women with preeclampsia after age 50. But, based on their research, the authors insist that maybe we should consider earlier screening and prevention efforts.The study fits into a growing body of evidence that pregnancy can act as a “stress test” for a woman’s cardiovascular system, revealing vulnerabilities that may otherwise remain hidden for years.
Similar research has linked preeclampsia and gestational diabetes to higher risks of heart disease, chronic hypertension, and kidney problems later in life. By mapping those risks onto specific stroke types, this research could help clinicians spot high-risk women earlier, and, ideally, intervene preemptively.
Bottom Line
Many women – and the doctors who treat them – view their pregnancy complications as isolated events that resolve once the baby is born. This study challenges that view, showing complications can present a lingering, hidden threat to the mother’s vascular health.
As Verburgt and her colleagues put it, “A history of pregnancy complications may identify women at increased risk of ischemic stroke at a young age, in particular atherosclerotic stroke.”
Further Reading
Researchers Find Link Between Rising Stroke Rates and Changing Temperatures
An Observational Study Among Third-Trimester Antenatal Women
