19 Feb Post Menopausal Stroke Risk Raised In Women With Later Life Pregnancy
MedicalResearch.com Interview with:
Dr. Adnan Qureshi MD
Professor of Neurology, Neurosurgery and Radiology
University of Minnesota
Medical Research: What is the background for this study?
Dr. Quershi: Women who have the last pregnancy at advanced age (usually defined as pregnancy at age of 40 years or greater) have higher risk of developing hypertension, hypertension related disorders, and diabetes mellitus during pregnancy. There is some evidence that disproportionately higher rates of cardiovascular risk factors continue years after the pregnancy. Perhaps there are unknown medical conditions triggered during pregnancy at advanced age. These changes continue to progress without being clinically evident until years later manifesting as a cardiovascular event.
Medical Research: What are the main findings?
Dr. Quershi: We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women’s Health Initiative Study. We determined the effect of pregnancy in advanced age (last pregnancy at age≥40 year) on risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period of 12 years. A total of 3306 (4.6%) of the 72,221 participants reported pregnancy in advanced age. Compared with pregnancy in normal age, the rate of ischemic stroke (2.4% versus 3.8%, p<0.0001), hemorrhagic stroke (0.5% versus 1.0%, p<0.0001), myocardial infarction (2.5% versus 3.0%, p<0.0001), and cardiovascular death (2.3% versus 3.9%, p<0.0001) was significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 60% more likely to experience a hemorrhagic stroke even after adjusting for differences in age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use and cigarette smoking were adjusted.
Medical Research: What should clinicians and patients take away from your report?
Dr. Quershi: It is well known that women who have pregnancy at the age of 40 years or greater have higher risk of developing complications during and immediately after pregnancy. The current study suggests that there may be long term consequences as well. The choice to become pregnant at age of 40 years or greater is an individual choice for the women. The study simply provides additional information regarding long term consequences that women need to take into account at the time of decision making.
The practical implications of the current findings need to be determined. Pre-conception counselling regarding the risks of pregnancy with advanced maternal age, promotion of optimal health and weight, and screening for concurrent medical conditions such as hypertension and diabetes is recommended for women aged > 40 years. Whether information regarding the long-term increased risk of cardiovascular diseases should be included in the pre-conception counselling needs to be considered further? The higher prevalence of certain cardiovascular risk factors in later life among women with last pregnancy at age ≥40 years would suggest a targeted cardiovascular assessment at regular intervals may be considered.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Quershi: Further studies may be necessary to both confirm the magnitude and mediators of increased risk conferred by pregnancy at age ≥40 years. Studies focusing on identifying protracted changes in cerebrovascular system in experimental models of pregnancy may be considered. Pregnancy leads to several physiological changes in the body for the women. The volume of circulating blood has to increase to supply both the mother and fetus. That places additional load on maternal heart and blood vessels. The ability to tolerate such physiological changes and additional cardiovascular work load perhaps decreases with increased age. Future studies need to study the short- and long-term effects of pregnancy on cerebrovascular physiology and blood vessels.
Qureshi AI, Saeed O, Malik AA, et al. Abstract WMP 50. Pregnancy in advanced age increases the risk of hemorrhagic stroke in post-menopausal women. Analysis of Women’s Health Initiative Study. Presented at the International Stroke Conference; February 17-19, 2016: Los Angeles, CA.
Dr. Adnan Qureshi MD (2016). Post Menopausal Stroke Risk Raised In Women With Later Life Pregnancy