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.

Women with high blood pressure in pregnancy may protect their brain health through better blood pressure management after giving birth, research has found.

Women who monitored and managed their blood pressure at home, with remote doctor support, had larger white matter volumes nine months after birth than those receiving standard postnatal care.

White matter links different brain regions; lower volumes have been associated with cognitive decline and conditions such as dementia.

The research, part of the NIHR Oxford Biomedical Research Centre-supported POP HT (Physician Optimized Postpartum Hypertension Treatment) trial led by Oxford researchers, suggests that improving blood pressure control soon after birth could make a difference.

Dr Winok Lapidaire is first author and principal investigator in cardiovascular medicine in the University of Oxford’s Radcliffe Department of Medicine.

The researcher said: “The study found that short-term postpartum optimisation of blood pressure after a hypertensive pregnancy was associated with larger brain volumes in the first year after the birth.

“Although the study did not assess long term outcomes, brain volume is a recognised marker of brain health and resilience to future decline.

“Our findings suggest that those early months after childbirth are an important window for supporting postpartum brain health and reducing the risk of future health problems in women who experienced hypertensive pregnancy.”

High blood pressure conditions in pregnancy, such as gestational hypertension (high blood pressure that develops during pregnancy) and pre-eclampsia (high blood pressure with protein in the urine), are linked to higher long-term risks of stroke, dementia and other neurological problems.

Earlier studies show women with these histories often have smaller brain volumes long after pregnancy.

Participants had either gestational hypertension or pre-eclampsia and required medication on discharge from hospital. Half self-monitored at home with remote clinical support; the rest received usual postnatal care.

Key finding: the self-management group had significantly larger white matter volumes at nine months than those given usual care.

Among women receiving standard care, those with previous pre-eclampsia showed smaller volumes in several structures than those with gestational hypertension.

These differences were not seen in the doctor-directed self-management group, suggesting improved control may offset effects associated with pre-eclampsia.

Earlier research by the POP HT team found that self-monitoring blood pressure after giving birth could help cut new mothers’ future risk of heart disease and strokes.