Late-Life Pregnancy Increases Risk of Hemorrhagic Stroke

LOS ANGELES—Women who are pregnant at age 40 or older are 60% more likely to have subsequent hemorrhagic stroke than women who are pregnant at younger ages, according to research presented at the International Stroke Conference 2016.

“Women with a late pregnancy need to be aware of their increased risk and take steps to improve their cardiovascular health,” said Adnan I. Qureshi, MD, Director of the Zeenat Qureshi Stroke Institute in St. Cloud, Minnesota. “Their doctors need to remain vigilant years later in monitoring these women’s risk factors through physical examination and, perhaps, more tests and earlier interventions to prevent stroke and other cardiovascular events.”

Adnan I. Qureshi, MD

Assisted reproduction techniques have enabled an increase in pregnancies among women age 40 or older. The complication rates associated with pregnancy after age 39 are higher, but the long-term health consequences are not known. Dr. Qureshi and colleagues analyzed data from the observational arm of the Women’s Health Initiative Study to determine the effect of pregnancy in advanced age (ie, last pregnancy at age 40 or older) on the incidence of cardiovascular events.

The researchers included data for 72,221 women ages 50 to 79 in their study. Using Cox proportional hazards analysis, they examined the effect of pregnancy in advanced age on the risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period of 12 years.

The study population’s mean age was approximately 66. About 83% of participants were white. In all, 3,306 (4.6%) of the participants reported pregnancy in advanced age. Compared with pregnancy at younger age, pregnancy in advanced age was associated with significantly higher rates of ischemic stroke (2.4% vs 3.8%), hemorrhagic stroke (0.5% vs 1.0%), myocardial infarction (2.5% vs 3.0%), and cardiovascular death (2.3% vs 3.9%).

In the multivariate analysis, after the researchers adjusted for age, race and ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use, and cigarette smoking, women with pregnancy in advanced age were 60% more likely to have hemorrhagic stroke. The investigators found no significant difference in the risk of ischemic stroke, myocardial infarction, and cardiovascular death among women with pregnancy in advanced age after adjusting for potential confounders.

The only cardiovascular risk factor that did not increase with later pregnancies in the study population was smoking, said Dr. Qureshi. Older pregnant women were less likely to smoke than younger women.

—Erik Greb