Preeclampsia linked to long-term cerebrovascular damage and worsened stroke outcomes

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preeclampsia (3 posts to May 2017)

Preeclampsia linked to long-term cerebrovascular damage and worsened stroke outcomes

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University of Vermont Larner College of MedicineJun 6 2025

Pre-eclampsia (PE), a serious hypertensive disorder that affects approximately 3–8% of pregnant women, is known to have long-lasting effects on the maternal vascular system. Women with a history of PE face a higher risk of developing conditions such as hypertension, hyperlipidemia, and even early-onset cognitive impairments later in life. Since PE causes widespread endothelial dysfunction, one concerning outcome is its potential to increase the risk of developing severe cerebrovascular complications, including stroke, in the postpartum period. However, how PE impacts the cerebral vasculature after childbirth remains unclear.

Previous studies in animal models of hypertension have shown that impaired cerebral vascular circulation worsens stroke outcomes. However, it remains uncertain whether similar circulatory impairments persist postpartum in individuals with a history of PE and whether these could lead to more severe stroke-related damage.

To address this gap, a team of researchers led by Professor Marilyn J. Cipolla from the University of Vermont, USA, induced experimental PE in rat models and studied the effects of a transient cerebral artery occlusion (or stroke) in them. Their findings were published in the journal Neuroprotection on 13 April, 2025.

"In the present study, we aimed to determine whether a history of PE impairs collateral recruitment and worsens ischemic stroke outcomes," explains Prof. Cipolla. The team used female Sprague-Dawley rats, randomly divided them into two groups: one group was fed a normal diet during pregnancy (NormP-PP), while the other received a high-cholesterol diet to induce PE (ePE-PP). Stroke was induced in both groups 4 to 9 months after delivery to examine the effects of prior PE. In addition, a separate set of postpartum rats from each group that were not subjected to stroke were examined to assess differences in cerebrovascular function.

The study revealed that rats with a history of PE (ePE-PP) had significantly worse stroke outcomes compared to their NormP-PP counterparts. This included increased infarct size and cerebral edema. Further analysis showed that infarct severity in the ePE-PP group was more closely related to reductions in blood perfusion, indicating a higher sensitivity to cerebral ischemia. Prof. Cipolla explains, "PE is associated with high levels of circulating oxidative stress markers, which may persist postpartum. Thus, we determined whether markers of oxidative stress were present in the PP period in response to stroke, and whether these markers were increased in ePE-PP rats." In line with their hypothesis, ePE-PP rats showed significantly elevated levels of oxidative stress markers in the blood were significantly higher in the ePE-PP group than in the NormP-PP group, suggesting that persistent oxidative stress may contribute to worse stroke outcomes in individuals with a history of PE.

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The researchers also analyzed the behavior of small arteries on the surface of the brain known as pial collaterals, which can provide alternate routes for blood flow in the event of a stroke. They found that these vessels exhibited greater pressure-induced constriction (myogenic tone) in ePE-PP rats. Moreover, the vessel diameters in this group were notably smaller in their active (contracted) state compared to the passive (relaxed) state across various pressure conditions-an abnormal response not seen in the NormP-PP rats.

Taken together, the findings indicate that PE has long-lasting adverse effects on the brain's vascular network, even months after pregnancy. The ePE-PP rats not only experienced more severe strokes but also showed increased vulnerability to ischemia and sustained oxidative stress, alongside abnormal responses in key blood vessels involved in collateral circulation. "Understanding the underlying mechanisms of PE's effects on the cerebrovasculature, both during the index pregnancy and months to years postpartum, may lead to the development of interventions for preventing stroke and improving cardiovascular outcomes in this vulnerable population," concludes Prof. Cipolla.

With further research into the prolonged impact of PE on maternal brain health, scientists may be able to uncover new ways to reduce stroke injury and enhance long-term well-being for women affected by this condition.

Source:

University of Vermont Larner College of Medicine

Journal reference:

Kropf, A., et al. (2025). History of pre‐eclampsia negatively impacts stroke severity postpartum in rats. Neuroprotection. doi.org/10.1002/nep3.70002.

Preeclampsia increases risk for early stroke

Be careful out there. You doctor should be able to compare stroke risk from this to birth control pills.
https://www.healio.com/cardiology/stroke/news/online/%7B6a627033-ddc3-48c4-a86e-2c92d04666e8%7D/preeclampsia-increases-risk-for-early-stroke?

January 29, 2018

Eliza C. Miller

Women with prior preeclampsia had an increased risk for early stroke compared with those who did not have preeclampsia, and this risk appears to be mitigated by aspirin use, according to an abstract presented at the International Stroke Conference.

“This study reinforces that we need to be thinking of preeclampsia as a major cardiovascular risk factor in women, one that we should be asking all our patients about,” Eliza C. Miller, MD, assistant professor of neurology at Columbia University College of Physicians and Surgeons, told Cardiology Today. “Current cardiovascular risk scores such as the Framingham or Reynolds scores or the Pooled Cohort Equations do not incorporate obstetric history, so we may be missing high-risk women who would benefit from more intensive preventive therapy.”

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Researchers analyzed data from 83,790 women (median age, 44 years at time of enrollment) from the California Teachers Study with no prior stroke at the time of enrollment in 1995. In the cohort, 4.9% had a history of preeclampsia.

Serial questionnaires were used to collect information on baseline characteristics in addition to medical and gynecological history. Patients were followed up through 2015, which included a review of hospital records for stroke outcomes.

Incident early stroke occurred in 0.62% of women without a history of preeclampsia and 0.93% of women with a history of preeclampsia.

The risk for early stroke was higher in women with a history of preeclampsia compared with those without a history of preeclampsia in an unadjusted analysis (HR = 1.5; 95% CI, 1.1-2.1) and after adjusting for hypertension, age, race, smoking, diabetes and obesity (HR = 1.24; 95% CI, 0.87-1.7).

Among those with preeclampsia, women who were taking aspirin had no increased risk for early stroke (adjusted HR = 0.7; 95% CI, 0.32-1.5), and those who were not taking aspirin had an elevated risk (adjusted HR = 1.4; 95% CI, 1-2.1).

“The fact that the increased stroke risk was not seen in women who were taking aspirin is extremely interesting and has not been shown before to my knowledge,” Miller told Cardiology Today.

Further research is needed, with a major focus on women with a history of preeclampsia.

“The time has come for a randomized clinical trial looking at aspirin or other preventive therapies in women with a history of preeclampsia — particularly women with early, preterm preeclampsia which has been shown to be a particularly strong risk factor in prior studies,” Miller said. “Women with a history of preeclampsia already get put on low-dose aspirin in subsequent pregnancies to prevent recurrent preeclampsia. Maybe they should just be continued on it long term. There’s no way to know without a randomized trial. What we can be sure of is that these women need to see primary care doctors regularly and have their risk factors addressed. One of the saddest things I see in my practice is women coming in with a stroke in their 50s, having not seen a doctor since the last time they had preeclampsia 20 years prior, not realizing that they were at increased risk.” – by Darlene Dobkowski

Reference:

Miller EC, et al. Abstract 174. Presented at: International Stroke Conference; Jan. 23-26, 2018; Los Angeles.

Study uncovers stroke risk factors for pregnant women with preeclampsia

Be careful out there.
http://www.news-medical.net/news/20170525/Study-uncovers-stroke-risk-factors-for-pregnant-women-with-preeclampsia.aspx

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May 25, 2017

Women with preeclampsia, a common complication of pregnancy, face a heightened risk of stroke during pregnancy and postpartum if they have urinary tract infections, chronic high blood pressure, or clotting or bleeding disorders, according to a study by Columbia University Medical Center (CUMC) and NewYork-Presbyterian researchers.
The study, among the most comprehensive analyses of its kind, was published online today in the journal Stroke.
"We have suspected that certain conditions raise the risk of stroke in women with preeclampsia, but few studies have taken a rigorous look at this issue," said lead author Eliza C. Miller, MD, a postdoctoral vascular neurology fellow in the department of neurology at NewYork-Presbyterian/Columbia University Medical Center. "Since strokes can be so devastating, it is critical to know whether these are just random events or due to modifiable risk factors."
Preeclampsia-;newly elevated blood pressure during pregnancy-;develops in about 3 to 8 percent of all pregnant women, according to the researchers. The cause of preeclampsia is not well understood. While preeclampsia can be mild and symptomless, it can quickly become severe. Left untreated, severe preeclampsia can have serious consequences for both mother and fetus. One of the most dangerous complications is pregnancy-associated stroke, which occurs up to 6 times as often in women with preeclampsia compared with pregnant women overall.
In the study, Dr. Miller and her colleagues analyzed the health records of 197 women who had a preeclampsia-related stroke and 591 women with preeclampsia who did not have a stroke, according to the New York State Department of Health inpatient database. The incidence of stroke in women with preeclampsia was over 200 per 100,000 deliveries, and more than one in 10 women in the study who had a preeclampsia-related stroke died in the hospital.

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"Women with preeclampsia who had chronic hypertension, bleeding or clotting disorders, or infections-;particularly urinary tract infections-;appeared to be at significantly increased risk of stroke," said Dr. Miller.
"The role of infection was perhaps the biggest question mark going into the study," said Dr. Miller. "Infections cause inflammation, which is known to play an important role in triggering stroke, especially in young people. Preeclampsia itself is an inflammatory disorder. Infections may be what pushed some of these women over the edge."
"The take-home message for pregnant women with preeclampsia and their doctors is to pay close attention to these risk factors, as well as to warning signs for stroke," said Dr. Miller. "It's important to note that the risk of stroke in women with preeclampsia doesn't end with delivery, as is commonly thought. About two-thirds of preeclampsia-related strokes occur after birth, when the mother has gone home. With all the stress of having a new baby, mothers sometimes ignore symptoms like headaches that could be a sign of a serious problem. They think, 'I'm tired, I just had a baby-;of course, I have a headache.' But this is not something to take lightly. Call your doctor if you have any signs and symptoms of stroke."

Source:

http://newsroom.cumc.columbia.edu/blog/2017/05/25/stroke-risk-factors-for-pregnant-women-with-preeclampsia-uncovered/