Preexisting Cerebrovascular Disease in Pregnancy: a Case Series on Pregnancy Outcomes
Sarah Wyckoff1, Gular Mammadli2, Whitney Booker3, Mary D'Alton3, Anita LaSala3, Stephanie Purisch 3, Linda Valeri5, Joshua Willey4, Eliza Miller4
1Columbia University Vagelos College of Physicians and Surgeons, 2Neurology, New York Medical College/Westchester Medical Center, 3Obstetrics and Gynecology, 4Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, 5Biostatistics, Columbia University Mailman School of Public Health
Objective:
To characterize adverse pregnancy outcomes (APO) in patients with preexisting cerebrovascular disease (CVD).
Background:
Detailed data are lacking regarding APO in pregnant patients with CVD, limiting neurologists’ ability to counsel patients.
Design/Methods:
We reviewed medical records of 35 patients with CVD evaluated in a neuro-obstetrics subspecialty clinic embedded within a high risk maternal-fetal medicine practice between August 2019 and December 2021. Patients were referred for neurological evaluation during or prior to pregnancy. We described subsequent maternal and fetal APO, including hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preterm birth (PTB), fetal growth restriction (FGR), and small for gestational age infant (SGA), as well as delivery mode, postpartum readmissions and recurrent acute CVD.
Results:
A total of 35 patients were included (6 TIA, 14 ischemic stroke, 1 subarachnoid hemorrhage, 1 intracerebral hemorrhage, 5 cerebral venous thrombosis, 3 unruptured aneurysm, 2 arteriovenous malformation, 1 cervical artery dissection, 2 reversible cerebral vasoconstriction syndrome [RCVS]). Average age at delivery was 33 years, and most patients (91%) had vascular risk factors including obesity (23%), chronic hypertension (20%), diabetes mellitus (11%), history of prior APO (26%), and migraine (57%). All patients with prior TIA, ischemic stroke, or cerebral venous thrombosis received antithrombotics during pregnancy. Overall, APO occurred in 44% of pregnancies, and included PTB (28%), HDP (19%), GDM (14%), FGR (8%), and SGA (8%). Cesarean deliveries occurred in 42% of pregnancies, all for obstetric indications. Two patients were readmitted postpartum, one for neurological symptoms (headache) with normal brain imaging, and one for an obstetrical complication. One patient experienced recurrent postpartum CVD (RCVS), without readmission.
Conclusions:
In patients with CVD history, APO were common but recurrent acute CVD was rare. Patients with prior CVD may be at high risk for APO due to underlying vascular risk factors rather than specific CVD diagnosis.
10.1212/WNL.0000000000201962