Multiple Pregnancies May Shield the Female Brain From Stroke

 Strokes during pregnancy are a problem your competent? doctor needs to prevent!

• pregnancy (14 posts to December 2011)

Multiple Pregnancies May Shield the Female Brain From Stroke

Summary: Conventional wisdom often jokes that having many children can “make you lose your mind,” but a new study suggests the opposite for brain health.

The research found that women who had three or more live births had a significantly lower risk of stroke and “covert” brain damage (vascular lesions). Given that women account for 57% of all strokes in the U.S., these findings offer a vital new tool for predicting and preventing neurological injury in females.

Key Findings

• The “Three-Birth” Threshold: After following 1,882 women over an 18-year period, researchers determined that three or more live births were consistently associated with a reduced risk of all-cause stroke.
• Reduced Vascular Injury: Women with three or more children also showed fewer signs of covert brain infarcts (brain lesions) and lower volumes of white matter hyperintensity.
• Unique Predictor: Interestingly, other factors like the use of hormone replacement therapy or specific estradiol levels did not show the same significant protective association in this cohort, making the number of live births a standout predictor.
• Statistical Rigor: The results remained significant even after researchers adjusted for major vascular risk factors like high blood pressure and cholesterol.

Source: UT San Antonio

While some say having lots of kids can make you lose your faculties, a new study suggests otherwise.

Research co-led by UT Health San Antonio, the academic health center of The University of Texas at San Antonio, associates a greater number of live births with a reduced risk of stroke or brain damage for mothers. As more women than men have strokes, the finding is seen as significant in helping determine risk.

The study, titled, “Number of Live Births as a Protective Factor Against Clinical and Covert Brain Infarcts: The Framingham Heart Study,” was published on April 7 in the Journal of the American Heart Association, and on behalf of the association.

“Our findings would suggest that reproductive factors – for example, number of live births – may be an additional factor to consider when assessing stroke risk in women,” said Sudha Seshadri, MD, a behavioral neurologist, professor and founding director of the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio.

She is joint senior author of the study with Emer R. McGrath, PhD, with the School of Medicine at the University of Galway in Ireland. “Inclusion of this risk factor in female-specific clinical prediction rules for stroke may enhance risk prediction in women,” Seshadri said.

Reproductive factors in stroke

The study notes that stroke is a major cause of morbidity and death and disproportionately affects women, who account for 57% of all strokes in the United States.

Reproductive factors – for example, age at first menstrual period, age at menopause, circulating estrogen levels, number of pregnancies and use of hormone replacement therapy – affect overall lifetime exposure to estrogen, and therefore have been implicated as important predictors of future stroke risk in women.

Generally, greater exposure for a longer period or to higher levels of the body’s own estrogen has recently been associated with a lower burden of cerebral small-vessel disease in women. However, evidence for some factors, such as live births, has been conflicting.

For this study, researchers determined the association between number of live births and other female-specific reproductive factors and subsequent risk of stroke and magnetic resonance imaging markers of vascular brain injury in a community-based cohort. That cohort was the Framingham Heart Study, a long-term and ongoing community-based observational study of residents in Framingham, Massachusetts, dating to 1948. Seshadri serves as senior investigator.

Live births and decreased risk

The scientists followed 1,882 women over time, and who were stroke-free at a baseline examination during 1998 to 2001 and at a mean age of 61. They considered reproductive factors including the women’s number of live births given, age at menopause, postmenopausal hormone replacement therapy use, and serum estradiol and estrone levels.

During a median 18-year follow-up, they assessed the same participants for number of strokes from all causes, and secondarily for “covert brain infarcts” – like brain lesions representing vascular damage from restricted or reduced blood blow – and white matter hyperintensity volume, detected by MRI.
 

Over that period, 126 women had strokes. The researchers used statistical analyses known as multivariable Cox proportional hazards models adjusting for major vascular risk factors, and determined that three or more live births were associated with a reduced risk of stroke. Similarly, they found that three or more live births were associated with decreased risk of vascular brain injury.

“This may be an important factor to include in female-specific clinical prediction rules for stroke, but will require further study,” Seshadri said.

The researchers found no significant association between other reproductive factors and stroke or MRI markers of vascular brain injury.

Other authors of the study are with Boston University; Mass General Brigham, Boston; and University of California-Davis.

Key Questions Answered:

Q: Does this mean pregnancy is “medicine” for the brain?

A: It suggests that the biological state of pregnancy and the resulting hormonal shifts provide a protective effect on brain vasculature. However, it’s one factor among many; diet, exercise, and genetics still play massive roles in stroke prevention.

Q: If I had fewer than three children, am I at higher risk?

A: Not necessarily. The study found that three or more births provided a statistically significant reduction in risk, but it doesn’t mean women with fewer children are doomed to have strokes. It simply highlights a biological “bonus” for those who have had more births.

Q: Why does estrogen protect the brain?

A: Estrogen is known to be “neuroprotective.” It helps maintain the elasticity of blood vessels and reduces inflammation. Longer lifetime exposure to your body’s own estrogen seems to keep the brain’s “plumbing” in better shape for longer.

Editorial Notes:

• This article was edited by a Neuroscience News editor.
• Journal paper reviewed in full.
• Additional context added by our staff.

About this neurology research news

Author: Steven Lee
Source: UT San Antonio
Contact: Steven Lee – UT San Antonio
Image: The image is credited to Neuroscience News

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

Pregnancy-associated strokes often go undetected despite typical symptoms

 Be careful out there. You really should expect your doctors to be more competent than this. which means your board of directors is failing at setting goals for the hospital and removing incompetence!

Pregnancy-associated strokes often go undetected despite typical symptoms

In a multicentre retrospective study, more than 1 in 4 pregnant or postpartum patients with acute stroke experienced a missed diagnostic opportunity, often despite having typical stroke presentations and recent medical encounters.

The findings, published in the journal Stroke, highlight a critical need for improved stroke recognition and timely neuroimaging -- particularly among obstetric and emergency clinicians -- to reduce diagnostic delays and improve outcomes in this high-risk population.

“Stroke prevention is vital,” said Eliza Miller, MD, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. “We must close diagnostic gaps to protect maternal health. Our findings show that early warning signs are often missed, especially by clinicians without neurology training, and that education across specialties is essential.”

The researchers conducted a retrospective study across 5 US comprehensive stroke centres, including 135 patients aged 18 to 50 years who were pregnant or within 1 year postpartum and had confirmed acute strokes -- including arterial ischemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, or cerebral venous thrombosis -- between 2012 and 2021. Each case was reviewed by vascular neurologists using the validated Safer Stroke-Dx tool to determine whether a missed diagnostic opportunity (MDO) occurred, and data on presenting symptoms, prior medical encounters, and contributing factors were collected.

The study found that 27% of patients experienced an MDO, most commonly due to failure to recognise stroke symptoms or omission of appropriate neuroimaging, despite nearly all having typical presentations. 

Notably, 92% of patients with MDO had at least 1 documented medical encounter in the month preceding the stroke, primarily with obstetric or emergency medicine clinicians. 

Haemorrhagic strokes were more common among patients with missed diagnoses, highlighting a critical need for enhanced clinician education and heightened vigilance for stroke in pregnant and postpartum populations to ensure timely recognition and treatment.

“Our analysis found that nearly half of patients who had seen a healthcare provider prior to stroke diagnosis were evaluated by obstetricians and approximately one third by emergency medicine clinicians,” said Miller. “This, to us, represents a knowledge gap across specialties and reveals an opportunity to expand clinician education to recognise early signs of maternal stroke.”

Reference: https://www.ahajournals.org/doi/10.1161/STROKEAHA.125.052995

SOURCE: University of Pittsburgh

Stroke in Pregnancy: An Update

 How will your doctor work with a functioning stroke doctor to guarantee you won't have a stroke via pregnancy? This is non-negotiable!

Stroke in Pregnancy: An Update

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https://doi.org/10.1016/j.ncl.2018.09.010Get rights and content

Section snippets

Key points

• •

  Pregnancy and puerperium confer a substantially increased risk of ischemic and hemorrhagic stroke in women, the rates of which have increased approximately 50% to 80% over the past 20 years.

• •

  The period of highest risk of stroke is the peripartum/postpartum phase, coinciding with the highest risk for hypertensive disorders of pregnancy and peak risk of gestational hypercoagulability.

• •

  Hemorrhagic stroke is the most common type of obstetric stroke, most commonly associated with hypertensive

Incidence, Prevalence, and Temporal Trends

Pregnancy and puerperium confer an increased risk for ischemic as well as hemorrhagic stroke, with incidence rates being 3-fold higher as compared with nonpregnant women. A recent meta-analysis of the epidemiologic characteristics and risk factors for stroke in pregnancy found that the mean age ranged from 22 to 33 years, and the crude incidence rate was 30/100,000 (95% confidence interval [CI], 18.8–49.4/100,000).¹ The rate of ischemic and hemorrhagic stroke was 12.2/100,000 pregnancies,

Patient Characteristics

A study of the Nationwide Inpatient Sample showed that the absolute risk of stroke increased with age: compared with patients younger than 20 years, those aged 35 to 39 years had an odds ratio (OR) for stroke of 2.0 (95% CI 1.4–2.7, P<.01) and those older than or equal to 40 years had OR of 3.1 (95% CI 2–4.6).⁵ One study found that younger women, but not older women, had an increased stroke risk during pregnancy and the postpartum state.⁶ Pregnancy at older age may, however, have negative

Hemodynamic Changes

During pregnancy, there is a high metabolic demand. To account for this, cardiovascular changes occur to allow the maternal circulation to meet new physiologic requirements. One of the initial changes is an increase in the plasmatic volume beginning early in the first trimester, secondary to an increase in renin activity as stimulated by estrogen and other circulating hormones. There is also development of mild hemodilutional anemia, and substantial increases in heart rate and cardiac output,

Hypertensive Disorders of Pregnancy

HDP are a group of conditions occurring in pregnancy and puerperium with a common background of hypertension, defined as BP greater than or equal to 140/90 mm Hg. Included in this group are gestational hypertension, preeclampsia, severe preeclampsia (eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome), and chronic hypertension with superimposed preeclampsia. HDP are of clinical relevance, given their prevalence and strong risk of cardiovascular disease and stroke during

Acute Ischemic Stroke Management

For nonpregnant patients with acute ischemic stroke, early thrombolytic therapy and endovascular clot retrieval are the recommended hyperacute therapies to improve long-term clinical outcomes. However, these therapies have not been studied in randomized trials involving pregnant women. Further, this therapy is often withheld in many women, given concerns for life-threatening maternal and placental hemorrhages, including risk of fetal demise. The most widespread used thrombolytic, tissue

Morbidity and Mortality

Stroke morbidity is determined by the type of stroke, its severity, and therapies received for early management and secondary prevention. Mortality rates for stroke in pregnancy are reported at 2.7% to 20.4% and have not significantly changed over the past decades, despite advances in stroke treatment.¹

Risk of Recurrent Stroke

For women of child-bearing age who have a stroke or VST, the risk of a recurrent stroke during pregnancy is not substantially high. A study of 441 women with a first ever stroke followed for

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Stroke occurs in 1 of every 2,222 pregnancy-related hospitalizations

 Be careful out there. Does this mean midwives should be used instead? Bad title. Of course the other problem is that outcomes can be worse when having a stroke in the hospital.

Stroke outcomes can be worse when they occur in hospital, Canadian study finds

Stroke occurs in 1 of every 2,222 pregnancy-related hospitalizations

Elgendy IY, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2019.10.056.
Sacco RL, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2019.11.029.

January 14, 2020

Islam Y. Elgendy

The rate of acute strokes in pregnancy-related hospitalizations did not decrease from 2007 to 2015, according to a study published in the Journal of the American College of Cardiology.
Acute stroke during pregnancy or shortly thereafter was linked to high maternal mortality, although this may be trending downward, according to the study.

See Also

• Sex differences in stroke risk factors persist
• ASA: 20 facts patients may not know about stroke
• In-hospital mortality due to acute stroke continues to decline

“In the recent years, there has been an increase in the incidence of maternal mortality rates in the United States, and cardiovascular disease is a leading cause,” Islam Y. Elgendy, MD, research fellow in medicine at Massachusetts General Hospital, told Healio. “This study evaluated the national trends of acute stroke among pregnant and postpartum women. We found that the rates of acute stroke during pregnancy have not changed or might be rising. We also found that the prevalence of most risk factors for acute stroke have been also increasing. Although, acute stroke is associated with high maternal mortality, reassuringly the rates of maternal mortality are decreasing.”
National Inpatient Sample data
Researchers analyzed data from 37,360,772 pregnancy-related hospitalizations (median age, 28 years) between January 2007 and September 2015 from the National Inpatient Sample. Information on baseline characteristics was collected including demographics and medical comorbidities.
The primary outcome was the incidence trend for acute stroke during pregnancy and the puerperium. Secondary outcomes were defined as the rates and trends of in-hospital mortality in women with stroke and the trends of risk factors for acute stroke during pregnancy.
Of the women in the study, 0.045% had an acute stroke, of which 47.2% was ischemic stroke/transient ischemic attack, 31% was hemorrhagic stroke and 21.8% was unspecified. The rate of acute stroke/TIA was largely unchanged from 42.8 per 100,000 hospitalizations in 2007 to 42.2 per 100,000 hospitalizations in 2015 (P for trend = .1), or approximately 1 for every 2,222 hospitalizations.
There was an increased prevalence in risk factors in women with acute stroke including smoking, obesity, atrial septal defects, hyperlipidemia, migraine, gestational hypertension and prior stroke. The prevalence of other traditional risk factors including diabetes and hypertension was unchanged.
Pregnant women with acute stroke/TIA had a 385-fold increased risk for in-hospital mortality compared with those without a stroke event (42.1 per 1,000 pregnancy-related hospitalizations vs. 0.11 per 1,000 pregnancy-related hospitalizations; P < .0001). In-hospital mortality rates in women with acute stroke/TIA decreased from 5.5% in 2007 to 2.7% in 2015 (P for trend < .0001).

PREGNANT women could hold the key to providing hope for stroke patients, following a breakthrough by Australian researchers.

Your doctor needs to followup this research and bring it into their hospital. Not following up is extreme incompetency. 
https://www.thesenior.com.au/health/new-hope-for-stroke-patients-2/

In a world first, scientists at Melbourne's La Trobe University have developed a groundbreaking treatment for stroke using discarded amniotic cells from pregnant women.

The teams found that injecting the stem cells - which line the amniotic sac during pregnancy and are discarded after birth - into stroke patients can significantly reduce brain injury and aid recovery.

Stroke is one of Australia's biggest killers and a leading cause of disability. Treatments for stroke are time critical and currently only a limited number of Australians have access to them.

The seven-year research project, led by La Trobe's Professor Chris Sobey and researchers from Monash University and Monash Health, found when human amnion epithelial cells were injected 90 minutes after stroke, the cells quickly homed in on the affected area of the brain, greatly reducing inflammation and nerve cell death.

"But what is particularly exciting about these new findings is that when the amniotic cells were administered as late as one or three days after stroke, there was accelerated healing and long term functional recovery was still greatly improved," Professor Sobey said.

Some of the most recent advancements in ischemic stroke treatment - strokes caused by a clot - can only be delivered within the first few hours of a stroke.

Professor Sobey said the reason this particular cell therapy was effective is because the cells are abundant, they are discarded after birth and don't require any treatment before being used.

"They already contain natural immune-suppressants, which means the patient's body won't reject them and they don't form tumours - both issues with other forms of cell therapy."

The first in-human trial in acute stroke patients will start soon, led by researchers at Monash Health and Monash University.

Recognise stroke: think FAST

F - Has their FACE drooped?

A - Can they lift both ARMS?

S - Is their SPEECH slurred and do they understand you?

T - Call 000, TIME is critical.

• More at strokefoundation.org.au

Rare type of stroke increasing among pregnant women

Be careful out there. You doctor should be able to compare stroke risk from this to birth control pills. 

Rare type of stroke increasing among pregnant women

16 January 2018 American Heart Association

• Under embargo until 24 January 2018 17:00 GMT

The proportion of a rare type of stroke, called spontaneous subarachnoid hemorrhage or sSAH, is increasing among pregnant women, according to preliminary research presented at the American Stroke Association’s International Stroke Conference 2018, a world premier meeting dedicated to the science and treatment of cerebrovascular disease for researchers and clinicians.

Spontaneous SAH is an abnormality within the brain’s arteries that weaken and leads to ruptures in the blood vessels on the surface of the brain, causing bleeding between the membranes surrounding the brain. Spontaneous SAH refers to hemorrhage that occurs without trauma to the head or neck.

Information about sSAH in pregnant women is scarce. This study examined how often these strokes occur among both pregnant and non-pregnant women, and how the pregnant women fare at discharge from the hospital as a marker for outcomes.

In a review of records obtained for 3,978 pregnant women, age 15 to 49, from 2002 to 2014 researchers found:

The percentage of pregnant women admitted to the hospital for increased from 4 percent to 6 percent.
The proportion of pregnant women with sSAH was highest among African Americans at 8 percent, followed by Hispanics at 7 percent, and Caucasians at 4 percent.
The percentage of pregnant women with sSAH was highest among 20- to 29-year-olds at 20 percent, and lowest among 40- to 49-year-olds at less than 1 percent.
“We need to increase awareness in the medical community about the increasing trend of spontaneous subarachnoid hemorrhage in pregnancy because management of these patients continues to be a clinical conundrum,” said study lead author Kaustubh Limaye, M.D., clinical assistant professor in the Division of Cerebrovascular Diseases at the University of Iowa in Iowa City.

After hospital admission, pregnant women with sSAH fared better than non-pregnant women with sSAH. Eight percent of pregnant women admitted to the hospital with stroke died, compared to 17 percent of non-pregnant women. Pregnant women also were more likely than non-pregnant women to be discharged from the hospital to home rather than to another medical facility.

“Pregnant women with spontaneous subarachnoid hemorrhage may have better outcomes than previously expected, which challenges prior findings from small, single-center reviews,” Limaye said.

The data came from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample - a national database that provides estimates of patients’ hospital stays. However, the database does not provide information about the severity of the stroke. Another limitation of the findings is the possibility that the database included cases incorrectly classified as stroke.

Co-authors are Achint Patel, M.D., M.P.H.; Sourabh Lahoti, M.D.; Cynthia Kenmuir, M.D., Ph.D.; James Torner, Ph.D.; Edgar Samaniego, M.D., M.S.; Santiago Ortega Gutierrez, M.D., M.S.; Ashutosh Jadhav, M.D., Ph.D.; Tudor Jovin, M.D.; and Enrique Leira, M.D., M.S. Author disclosures are on the abstract.

The National Institute of Neurological Disorders and Stroke partially supported Dr. Limaye’s salary.

https://newsroom.heart.org/news/rare-type-of-stroke-increasing-among-pregnant-women?preview=34b9a5e8ad6f78d021846f5fe562832c

• Full bibliographic informationInternational Stroke Conference 2018
  Meeting Report Presentation 36 - Session: A6
  
  Authors: KAUSTUBH LIMAYE, Univ of Iowa, Iowa City, IA; Achint Patel, UAMS, Little Rock, AR; Sourabh Lahoti, Emory, Atlanta, GA; Cynthia Kenmuir, UPMC, Pittsburgh, PA; James Torner, Edgar Samaniego, Santiago Ortega Gutierrez, Univ of Iowa, Iowa City, IA; Ashutosh Jadhav, Tudor Jovin, UPMC, Pittsburgh, PA; Enrique Leira, Univ of Iowa, Iowa City, IA

The incidence of pregnancy-related stroke: A systematic review and meta-analysis from the WSO

I don't listen to anything from the WSO, up to you or your doctor to tell you about this.
https://www.podbean.com/media/share/pb-2d5pg-71ddeb#.Wa4tBqEh1FE.facebook

Multiparity improves outcomes after stroke in female mice

Be careful out there.
http://www.news-medical.net/news/20170628/Multiparity-improves-outcomes-after-stroke-in-female-mice.aspx

• Download PDF Copy

June 28, 2017

Stroke is an age-related disease that disproportionately affects women. Although experimental studies have identified several hormonal and genetic factors underlying these differences, little is known about how pregnancy influences risk as this has not been previously studied in the laboratory setting. However, new research published in the Proceedings of the National Academy of Sciences shows that while perimenopausal female mice that gave birth multiple times (multiparous) were at higher risk of stroke, they recovered better than mice that had not ever reproduced.
"Pregnancy and parturition have lasting effects on the brain and its response to injury," said Rodney Ritzel, PhD, a postdoctoral fellow at the University of Maryland School of Medicine and lead author of the study "Multiparity improves outcomes after cerebral ischemia in female mice despite features of increased metabovascular risk."

Multiparous mice, or females that have given birth more than once, typically exhibited many factors that put them at higher risk for stroke, the study found. This included increased body weight, elevated triglyceride and cholesterol levels, significant immune suppression, greater sedentary behavior and muscle fatigue. While these attributes are generally associated with higher metabovascular risk, the female mice that had given birth multiple times demonstrated a surprising resistance to ischemic brain injury and improved behavioral recovery at chronic time points after stroke, the study found.
"Mice that were pregnant and had given birth had less brain inflammation, smaller brain injuries, and recovered better after stroke, despite showing signs of increased cardiovascular risk," Dr. Ritzel said.
The study examined the role of pregnancy and parturition on neurovascular function and behavior in both normal female mice and in females exposed to stroke. The research found that reproductive experience increases systemic metabolic risk and results in significant behavioral deficits that are associated with central nervous system immunosuppression. After stroke, however, multiparous females exhibited smaller infarct volumes, attenuated inflammatory responses, enhanced angiogenesis, and improved behavioral recovery.
Ritzel added that this study provides valuable insight into stroke recovery in women. He highlighted the importance of modeling the differences between child-bearing and non-child-bearing women when researching the impact of strokes and other brain injury.

Source:

University of Maryland School of Medicine

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

• Download PDF Copy

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/

Study finds increased risk of pregnancy-associated stroke among young women

Be careful out there.
http://www.news-medical.net/news/20161025/Study-finds-increased-risk-of-pregnancy-associated-stroke-among-young-women.aspx

Pregnancy was not found to raise the risk of stroke in older women, according to a study from Columbia University Medical Center and NewYork-Presbyterian. In younger women, however, the risk of stroke was significantly higher for those who were pregnant.
The researchers published their findings today in JAMA Neurology.
Pregnancy-associated stroke occurs in an estimated 34 out of 100,000 women. Previous studies suggested that the risk of pregnancy-associated stroke is higher in older women than in younger women.
"The incidence of pregnancy-associated strokes is rising, and that could be explained by the fact that more women are delaying childbearing until they are older, when the overall risk of stroke is higher," said Joshua Z. Willey, MD, assistant professor of neurology at CUMC, assistant attending neurologist on the stroke service at NewYork-Presbyterian/Columbia, and a senior author on the paper. "However, very few studies have compared the incidence of stroke in pregnant and non-pregnant women who are the same age."

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In this study, the researchers examined data collected on every woman hospitalized for stroke in New York State between 2003 and 2012. Of these 19,146 women, age 12 to 55 years, 797 (4.2 percent) were pregnant or had just given birth.
The researchers found that the overall incidence of stroke during or soon after pregnancy increased with age (46.9 per 100,000 in women age 45 to 55 vs 14 per 100,000 in women age 12 to 24).
However, pregnant and postpartum women in the youngest group (age 12 to 24) had more than double the risk of stroke than non-pregnant women in the same age group (14 per 100,000 in pregnant women vs 6.4 in non-pregnant women).
For women age 25 to 34, pregnancy increased the risk 1.6 times. Stroke risk was similar in pregnant and non-pregnant women in the older age groups.
"We have been warning older women that pregnancy may increase their risk of stroke, but this study shows that their stroke risk appears similar to women of the same age who are not pregnant," said Eliza C. Miller, MD, a vascular neurology fellow in the Department of Neurology at CUMC and NewYork-Presbyterian and lead author of the study. "But in women under 35, pregnancy significantly increased the risk of stroke. In fact, 1 in 5 strokes in women from that age group were related to pregnancy. We need more research to better understand the causes of pregnancy-associated stroke, so that we can identify young women at the highest risk and prevent these devastating events."

Source:

Columbia University Medical Center

Successful gestation and delivery using clopidogrel for secondary stroke prophylaxis: a case report and literature review.

In case you are pregnant and need to be on a blood thinner, this is a case report that your doctor should already know about.
http://dgcases.docguide.com/node/46505

Literature is scarce regarding the use of clopidogrel during pregnancy and the potential hazard to maternal and fetal health. We report a 33-year-old female, who presented to our clinic at 40 weeks gestation with a history of multiple prior ischemic strokes and transient ischemic attacks. The patient was placed on clopidogrel for secondary stroke prophylaxis prior to conception and maintained therapy throughout pregnancy without interruption or complication. Clopidogrel was discontinued 7 days prior to induction of labor, and a healthy baby was vaginally delivered without bleeding complications or congenital anomalies. Clopidogrel was restarted 12 hours postpartum without an incident. To our knowledge, this is the first report of clopidogrel use in pregnancy for secondary stroke prophylaxis. We also provide a current review of the literature of the use of clopidogrel in pregnancy. Based on the limited data available, clopidogrel use in pregnancy has not demonstrated significant toxicity to either the mother or the newborn. However, additional studies are needed to further assess the efficacy and safety of this medication in this patient population.

from: University of Central Florida College of Medicine, Orlando, FL, USA..

How pregnancy might stimulate memory

This was fascinating for the part about dendritic spines. From an email from Lumosity.  Original article below. I can see this as extremely important to us because we would need these dendritic spines to go around dead/damaged areas.

Prior research has found that certain female hormones such as oestradial and progesterone significantly increase the number of dendritic spines in the brain. Dendrites are what neurons use to reach out and connect with each other—so the more dendrites, the higher possibility of neural connections. Because these dendrite-enriching female hormones surge and stay high during pregnancy, researchers from the University of Richmond hoped to find significant differences in the brains of maternal rats.

In this 1999 study from the journal Nature, maternal rats were almost three times as fast at navigating to the food reward when put through a maze test. Maternal rats took only 43.2 seconds, compared to 128 seconds among non-maternal females. Researchers postulate that maternal rats had brains better adapted to the task of navigation because of its import role in supporting young—in this case, locating and securing food resources.
Here is the actual article

Motherhood improves learning and memory

 

Neural activity in rats is enhanced by pregnancy and the demands of rearing offspring.

When a female mammal makes the transition from virginity to motherhood, she is forced to refocus her activities dramatically. She must adapt to a multitude of new demands by her offspring or risk losing a significant metabolic and genetic investment.

Subarachnoid Hemorrhage Risk Factors In Pregnant Women

Be careful out there.
http://www.medicalnewstoday.com/articles/240879.php
Approximately 1 in every 15,000 pregnant women will develop subarachnoid hemorrhage (SAH) - bleeding in the area between the brain and the thin membranes that cover the brain, according to a study published in the February issue of Anesthesiology.

Pregnancy and stroke

For the women out there, be careful.
http://www.letsgosc.org/2011/11/pregnancy-and-stroke/

The chance that a woman would have a stroke while she is pregnant is very small, but a study finds it’s changing. At the Centers for Disease Control and Prevention, Elena Kuklina looked at hospitalizations between 1994 and 2007:

“The rate of stroke is rising in pregnant women and in women who have just given birth.’’

Kuklina says the rate went up by about 50 percent in all pregnancy-related strokes, to about 3,000 a year by 2007.

Kuklina says people can reduce their risk of stroke by not smoking; eating a low-fat, low-sodium, high-fiber diet; being physically active – and controlling weight, even before pregnancy.

The study was in the journal Stroke.