Mental health
Stroke during pregnancy linked to long-term heart and mental health risks

Stroke during pregnancy and postpartum is associated with higher long-term risks of cardiovascular events and depression, a study has found.
Researchers from the University of Helsinki in Finland identified 97 female participants in Finnish healthcare registries who had an ischaemic stroke (the most common type of stroke, which occurs when a clot or blockage reduces blood flow to the brain, depriving it of oxygen and nutrients) during pregnancy or postpartum, up to three months after pregnancy.
They were matched to 280 female participants who did not have a stroke.
Researchers tracked the health of each person through registries and medical records for an average of 12 years, noting which participants later had cardiovascular events such as heart attack, stroke and heart disease or depression.
Of participants with an initial stroke, six per cent had a second stroke and seven per cent had a major cardiovascular event such as heart attack compared to zero per cent of those who were stroke-free at the start of the study.
Anna Richardt, study author from the University of Helsinki, said: “Having a stroke during pregnancy or postpartum is rare but several studies have shown it is on the rise.
“Our study sought to better understand what happens to women after a stroke during pregnancy and postpartum and found an increased risk of cardiac diseases and depression, as well as lower odds of being employed later.”
Researchers also found among participants with stroke, nine per cent had cardiac disease, including atrial fibrillation (an irregular heartbeat) or congestive heart failure (when the heart cannot pump blood effectively), compared to one per cent of those who did not have stroke.
After adjusting for age, participants with stroke had a nearly nine times greater odds of having cardiac disease.
Of participants with stroke, 19 per cent had depression compared to six per cent of those without stroke. After adjusting for age, those with stroke had nearly four times greater odds of having depression.
Researchers also reviewed employment statistics.
Of participants with stroke, 71 per cent were employed two years prior to their stroke compared to 76 per cent of those without stroke. By the end of the study, 66 per cent of those with stroke were employed compared to 78 per cent of those without stroke.
After adjusting for age, researchers found that participants with stroke had 45 per cent lower odds of being employed and nearly five times greater odds of being retired at the end of the study compared to those without stroke.
Richardt said: “Of those with stroke, 92 per cent had good functional outcomes, meaning they had either completely recovered or could manage most daily activities by the end of the study.
“Still, more than one-third of those with stroke were out of work at the end of the study.
“Our findings highlight the need for adequate stroke prevention, monitoring and rehabilitation to improve the long-term health for those who have stroke during pregnancy.”
A limitation of the study was the small number of participants with stroke since stroke during pregnancy is rare.
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Menopause
CBT shows promise for menopause insomnia and hot flashes

Cognitive behavioural therapy (CBT) may offer short-term relief for menopause insomnia and night-time hot flushes, a pilot study suggests.
CBT is a structured, short-term talking treatment that helps people change thoughts and behaviours that can worsen sleep problems.
Researchers found the intervention was linked to meaningful short-term improvements in insomnia severity, hot flush interference, sleep self-efficacy, or confidence around sleep, and depressive symptoms.
The Menopause Society said insomnia affects an estimated 20 to 60 per cent of perimenopausal and postmenopausal women in the US.
Ongoing research is focusing on effective treatments because insomnia can have serious physical and psychological effects.
Dr Monica Christmas, associate medical director for The Menopause Society, said: “Nocturnal hot flushes (night sweats) and sleep disruption can have a significant effect on the quality of life with many women claiming extreme impairment due to symptoms that often start in early perimenopause and last 10 or more years.”
“Sleep disturbances can persist even in those using pharmacological therapy to manage hot flushes.
“The study’s findings highlight the utility of cognitive-behavioural therapy as a standalone treatment for insomnia and hot flushes, offering women an alternative or adjunct to pharmacological treatments.”
Insomnia is defined as disturbed sleep associated with distress or impaired daily functioning and is one of the most common complaints in perimenopause and postmenopause.
It can reduce quality of life and is linked to higher healthcare use and costs, disability, depression and cardiovascular disease.
Hot flushes occur in 60 to 80 per cent of women during the menopause transition and can persist for four to five years on average.
Night-time hot flushes are linked to sleep disruption, and women may respond by napping or spending longer in bed, which can help keep insomnia going.
Previous studies have shown that cognitive behavioural therapy is an effective treatment for insomnia and may also help women cope with hot flushes and other menopause symptoms.
However, few trials have looked at both insomnia and hot flushes together.
Insomnia during and after the menopause transition is complex and can have many causes, including ageing, hormone fluctuation, hot flushes, other sleep disorders, psychiatric and medical conditions and psychosocial stressors.
Because women with acute and sustained insomnia can experience greater negative health effects, effective treatment is important.
The pilot study concluded that CBT was feasible and may be a promising approach for menopause-related insomnia and nocturnal hot flushes, although the benefits appeared to lessen after three months.
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