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Maternal Stroke: an Update

  • Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Maternal morbidity and mortality is rising in the USA, and maternal stroke is a major contributor. Here, we review the epidemiology, risk factors, and current recommendations for diagnosis and acute treatment of ischemic and hemorrhagic stroke during pregnancy and postpartum, focusing on recent evidence.

Recent Findings

The incidence of maternal stroke has risen in recent years, possibly due to increasing rates of hypertensive disorders of pregnancy. The risk of maternal stroke is highest in the peripartum and early postpartum period. Preeclampsia is highly associated with reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome and is also associated with long-term increased risk of stroke and vascular dementia. Hypertensive disorders of pregnancy, migraine, and infections are risk factors for maternal stroke. Limited data suggest that thrombolytics and endovascular reperfusion therapy are safe and effective in pregnant women with ischemic stroke, but few data are available regarding safety of thrombolytics in the postpartum period. New consensus guidelines are now available to assist with management of ischemic and hemorrhagic stroke in pregnancy.

Summary

Many gaps remain in our understanding of maternal stroke. While risk factors have been identified, there are no prediction tools to help identify which women might be at highest risk for postpartum stroke and require closer monitoring. The risk of recurrent maternal stroke has not been adequately quantified, limiting clinicians’ ability to counsel patients. The complex pathophysiology of preeclampsia and its effects on the cerebral vasculature require further targeted study. An increased focus on the prevention, recognition, and optimal treatment of maternal stroke will be critical to reducing maternal morbidity and mortality.

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Authors and Affiliations

  1. Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    Maria D. Zambrano & Eliza C. Miller

  2. Neurological Institute of New York, 710 West 168th Street, 6th floor, New York, NY, 10032, USA

    Eliza C. Miller

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  1. Maria D. Zambrano
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Correspondence to Eliza C. Miller.

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Dr. Zambrano declares no conflict of interest. Dr. Miller receives research funding from the National Institutes of Health National Center for Advancing Translational Sciences (KL2TR001874), and from the Louis V. Gerstner Foundation, and receives personal compensation from medicolegal consulting related to maternal stroke.

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Zambrano, M.D., Miller, E.C. Maternal Stroke: an Update. Curr Atheroscler Rep 21, 33 (2019). https://doi.org/10.1007/s11883-019-0798-2

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