AHA Scientific Statement Addresses Maternal Stroke Prevention and Treatment

 Nothing on 100% recovery; SO, A COMPLETE FUCKING FAILURE! Doesn't anyone in stroke know what survivors want?

AHA Scientific Statement Addresses Maternal Stroke Prevention and Treatment

 A scientific statement regarding the treatment and prevention of maternal stroke in pregnancy and postpartum has been published by the AHA. The American Heart Association (AHA) has released a scientific statement on the prevention and treatment of maternal stroke in pregnancy and postpartum, as published inStroke. The statement addresses current research on the epidemiology, pathophysiology, prevention, and treatment of maternal stroke and provides best practice suggestions. The physiologic hypercoagulable state of pregnancy, cardiovascular and immunologic adaptations, and infections during pregnancy are associated with the risk for stroke. Hypertensive disorders of pregnancy, which include gestational hypertension, preeclampsia/eclampsia, and chronic hypertension with superimposed preeclampsia, are common and may increase stroke risk by up to 5-fold, the AHA writing group noted. Diabetes and obesity are associated with a higher stroke risk, and Black pregnant women have disproportionately increased rates of stroke. Hemorrhagic stroke occurs more frequently in pregnant women compared with nonpregnant women, and ischemic stroke accounts for a high proportion of pregnancy-associated strokes. The risk for pregnancy-associated cerebral venous thrombosis is increased by more than 8-fold, compared with nonpregnant women, according to the writing group. Continued research, including inclusive clinical trials, is urgently needed to refine stroke risk assessment, to expand treatment options, and to improve maternal outcomes. Primary stroke prevention should be followed for all individuals capable of pregnancy, using the 2024 AHA/American Stroke Association Guideline for the Primary Prevention of Stroke, according to the authors. The approach includes screening for modifiable behaviors, medical conditions, and social determinants of health, such as food insecurity or lack of transportation. Targeted primary prevention strategies may be needed for women with a higher risk for stroke. Research supports treating chronic hypertension in pregnancy before it becomes severe, and postpartum hypertension management is less defined in guidelines. Magnesium sulfate is recommended for seizure prevention, antihypertensive medications are recommended to lower stroke risk, and daily low-dose aspirin may significantly decrease the risk for preeclampsia in high-risk individuals. Among pregnant patients with congenital heart disease, the use of antiplatelet and antithrombotic agents should be guided by a cardio-obstetrics collaborative team, according to the writing group. Aspirin is recommended for primary prevention of stroke in patients with antiphospholipid syndrome, regardless of pregnancy status. Management of patients with aneurysms or arteriovenous malformation during pregnancy requires a multidisciplinary team to guide individualized prevention and management strategies. The goal of secondary prevention is decreasing the recurrent stroke risk in women with cerebrovascular events. Low-doseaspirin is generally safe for most pregnant patients with ischemic stroke or transient ischemic attack. In high-risk patients, therapeutic anticoagulation with low-molecular-weight heparin during pregnancy is usually recommended. The writing group suggests creating a multidisciplinary team that includes vascular neurology, emergency medicine, maternal-fetal medicine or obstetrics, obstetric anesthesiology, and neonatology when appropriate for pregnant or postpartum patients. Evidence supports use of hyperacute reperfusion therapies in the peripartum period for pregnant and breastfeeding women. A multidisciplinary team involving maternal-fetal medicine, neurology/neurocritical care, anesthesiology, neonatology, and nursing is needed for pregnant patients who deliver while recovering from an acute stroke, according to the authors. Expedited delivery may be warranted in cases in which maternal neurologic or cardiovascular status deteriorates. Following acute stroke in a high-acuity setting, close monitoring is recommended in pregnant or postpartum patients for at least 24 to 72 hours. About one-third of pregnant or postpartum patients may have residual deficits, depending on stroke type and severity, and follow-up with a vascular neurologist is needed to support recovery, according to the authors. Breastfeeding and pumping breastmilk can generally be used in lactating stroke survivors but may require adaptations. Contraceptive counseling should take into account patient preferences, stroke cause, and underlying hypercoagulable conditions, and estrogen-containing contraceptives are associated with an increased stroke risk. Mood and sleep disorders also are common poststroke and may become worse with postpartum factors such as hormonal shifts, infant care demands, and sleep disruption. Severe maternal morbidity, including pregnancy-related stroke, is associated with an increased risk for postpartum mood disorders. “This scientific statement represents a multidisciplinary effort to synthesize current knowledge and to offer consensus-driven suggestions for prevention, acute management, and postpartum recovery in maternal stroke,” the AHA writing group wrote. “Continued research, including inclusive clinical trials, is urgently needed to refine stroke risk assessment, to expand treatment options, and to improve maternal outcomes.” Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. This article originally appeared on The Cardiology Advisor

References:

Miller EC, Bello NA, Chen PR, et al; on behalf of the American Heart Association Women’s Health Science Committee of the Council on Clinical Cardiology and Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Prevention and treatment of maternal stroke in pregnancy and postpartum: a scientific statement from the American Heart Association. Stroke. Published online January 28, 2026. doi: 10.1161/STR.0000000000000514