TOPLINE:

Women with maternal ischemic stroke show good functional recovery, with more 90% achieving independence, but face eightfold higher risk for cardiac disease and are less likely to remain employed.

METHODOLOGY:

• Researchers conducted a retrospective nationwide cohort study of 97 maternal ischemic stroke patients in Finland during 1987-2016, with 280 matched controls selected on the basis of delivery year, age, parity, and geographical area.
• Analysis included mortality data until 2022 (median follow-up period, 17.4 years) and morbidity/vocational status until 2016 (median follow-up period, 11.6 years) from national healthcare registers.
• Patient records were reviewed by stroke neurologists to verify ischemic stroke diagnosis, estimate functional outcomes using the modified Rankin scale (mRS), and assess recovery at hospital discharge, 3 months, and end of follow-up.
• Investigators collected data on cardiovascular diseases, depression, and vocational status from Hospital Discharge Register and Statistics Finland for cases surviving more than 1 year after stroke.

TAKEAWAY:

• Overall mortality was higher in maternal ischemic stroke patients vs control individuals (8.3% vs 1.8%; age-adjusted odds ratio [aOR], 4.96; 95% CI, 1.58-15.60), though differences were not significant after the first year.
• Compared with control individuals, patients showed increased risk for cardiac diseases (aOR, 8.57; 95% CI, 2.22-33.08), depression (aOR, 3.92; 95% CI, 1.86-8.24), and major cardiovascular events (6.7% vs 0%; P < .001).
• Among survivors, 92.1% achieved good functional outcomes (mRS, 0-2), yet employment was less common (aOR, 0.55; 95% CI, 0.32-0.94) and retirement more frequent (aOR, 4.55; 95% CI, 2.03-10.17) than among control individuals.
• Recurrent stroke occurred in 5.6% of maternal ischemic stroke patients, with 42.9% of recurrences happening during subsequent pregnancies.

IN PRACTICE:

“Optimizing long-term prognosis in these young patients necessitates comprehensive management of vascular risk factors and targeted rehabilitation strategies to address residual neurologic deficits,” the authors of the study wrote.

SOURCE:

The study was led by Anna Richardt, University of Helsinki and Helsinki University Hospital in Helsinki, Finland. It was published online in Neurology.

LIMITATIONS:

According to the authors, the cohort size was relatively small due to the rarity of maternal ischemic stroke and Finland’s population size, which may have led to both type I and II statistical errors and limit statistical power, especially in subgroup analyses. The functional outcomes were estimated retrospectively from patient records rather than systematically assessed, potentially leading to underestimation of cognitive and other nonmotor stroke symptoms. Additionally, while the follow-up time was substantial, it remains relatively short for fully assessing cardiovascular burden and mortality later in life.

DISCLOSURES:

The study received competitive state research funding for the responsibility area of the Helsinki and Uusimaa Hospital District in 2017-2018 and research funding from the Neurocenter of Helsinki University Hospital in 2019-2020. Richardt disclosed receiving a personal grant from Biomedicum Foundation and serving in a funded working position in University of Helsinki. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.