A multinational study of 1013 women found that pregnancy following cervical artery dissection was not associated with an increased risk of stroke, recurrent dissection, or death.
Led by Sandro K. Fischer, MMed, of the University of Basel in Switzerland, the researchers analyzed data from 33 stroke centers in 9 countries that were collected between May 1, 1990, and April 30, 2023. All participants had a history of cervical artery dissection (CeAD) and were followed for a median of 5.3 years (interquartile range [IQR] = 2–11.3 years). A small proportion of women in the cohort (114; 11.3%) became pregnant at least once after their initial dissection, while 899 (88.7%) did not.
The main outcome was a composite of recurrent CeAD, ischemic or hemorrhagic stroke, or all-cause death during follow-up at least 6 months following initial CeAD. This outcome occurred in 10 of 114 women (8.8%) who became pregnant and 65 of 899 (7.2%) who did not. The unadjusted hazard ratio (HR) for the pregnancy group compared with the nonpregnancy group was 1.08 (95% confidence interval [CI] = 0.56–2.08), and the age-adjusted HR was 0.77 (95% CI = 0.38–1.56).
Among the 10 women in the pregnancy group who experienced an event, 7 had recurrent CeAD, 2 had ischemic strokes unrelated to CeAD, and 1 had an intracerebral hemorrhage. No deaths occurred. Five events (4 recurrent CeADs and 1 ischemic stroke) occurred within 6 weeks postpartum. No events were reported between 6 and 12 weeks postpartum.
In the nonpregnancy group, 32 women experienced recurrent CeAD, 26 had ischemic strokes, 4 had intracerebral hemorrhages, and 5 died. Two patients in this group experienced multiple events.
Over 7393 patient-years, the event rate for the composite outcome was 1% per patient-year (1.1% in the pregnancy group, and 1% in the nonpregnancy group). The incidence of recurrent CeAD was 0.74% per patient-year (95% CI = 0.30%–1.52%) in the pregnancy group and 0.50% (95% CI = 0.34%–0.70%) in the nonpregnancy group.
Among the 114 women who became pregnant, there were 158 total pregnancies, including 122 deliveries and 36 miscarriages or abortions. Cesarean delivery occurred in 72 of 122 pregnancies (59%). Delivery mode was not clearly linked to recurrence risk. "The 7 women who became pregnant after CeAD and who had recurrent CeAD had 11 pregnancies, of which 9 ended successfully with delivery," the authors wrote. "Delivery was vaginal in 4 and cesarean in 5 patients, respectively. In the 4 patients with recurrent CeAD during the pregnancy period, mode of delivery...was vaginal in 3 and cesarean in 1." None had a pregnancy-related initial CeAD.
Sensitivity analyses by age at initial CeAD (categorized by age limits up to 42, 45, and 49 years) showed consistent findings. Age-adjusted HRs for the composite outcome ranged from 0.72 to 0.77.
While most events in the pregnancy group occurred postpartum, the overall frequency remained low. "These findings may be helpful for individual counseling and family planning for women with prior CeAD," the authors concluded.
Full disclosures can be found in the published study.
Source: JAMA Network Open