Preeclampsia and stroke in later life

Bob Kronemyer

Freelance writer for Contemporary OB/GYN

Women with a history of preeclampsia were nearly 4 times as likely to have a stroke in later life compared with women without a history of preeclampsia, according to an analysis of data from the Framingham Heart Study, which was conducted from 1948 to 2016.

“I am interested in the long-term effects of exposures earlier in life, including how preeclampsia affects the risk of stroke,” said principal investigator Adam de Havenon, MD, an assistant professor of neurology at the University of Utah in Salt Lake City.

The analysis in JAMA Network Open included 1,435 women with and without a history of preeclampsia. The mean age was 44.4 years at the beginning of the study and all were White.

Inclusion criteria were women who were stroke-free at enrollment and had a minimum of 3 study visits and 1 pregnancy before menopause, hysterectomy or age 45.

Data on vascular risk factors, history of preeclampsia, and stroke incidence were collected biannually.

A total of 41,422 person-years of follow-up comprised the analytic sample.

Of the entire cohort, 11.8% (n = 69) had a history of preeclampsia and 16.1% (n = 231) experienced a stroke during follow-up.

The analysis found a relative risk of 3.79 (95% confidence interval [CI]: 1.24 to 11.60) for stroke in women with a history of preeclampsia, after controlling for vascular risk factors across the life course using a statistical method that allowed the vascular risk factors to vary over time.

Stroke events occurred at a mean of 32.4 years from baseline, affecting 17.8% of women with a history of preeclampsia and 15.9% of women without a history of preeclampsia.

“While these results are consistent with prior research, we were able to use the consistent and regular follow-up during the Framingham study to account for the midlife development of vascular risk factors, such as hypertension or smoking, to further strengthen the association between preeclampsia and stroke,” de Havenon told Contemporary OB/GYN®.

Because stroke transpired at a mean of more than 3 decades after the preeclampsia, “this indicates that aggressive medical management of vascular risk factors during midlife has the potential to reduce the risk of stroke,” he said.

At baseline, women with preeclampsia were significantly younger than those without a history of preeclampsia (mean 44.4 years vs. mean 48.9 years, respectively). Also, more likely to receive cholesterol-lowering medications (2.4% vs. 0.4%), have lower serum total cholesterol levels (mean 226.2 mg/dL vs. 234.4 mg/dL) and higher diastolic blood pressure (mean 86.4 mm Hg vs. 83.6 mm Hg).

Women with preeclampsia were also significantly more likely to currently smoke (47.9% vs. 36.7%).

“Research is needed to explore the practical implications of this association, particularly regarding the implementation of additional monitoring of vascular health among women with a history of preeclampsia and the use of lower thresholds for medical and lifestyle interventions to improve vascular health,” de Havenon said.

More research also is needed to clarify the mechanisms of long-term change induced by a preeclamptic pregnancy, de Havenon said. “We are doing prospective research on women who had preeclampsia less than 10 years ago to understand if their arteries are stiffer and if their brains have early signs of chronic injury. These intermediate markers could be useful to understand this relationship and potentially a target, if aggressive treatment is instituted earlier in life,” he said.

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de Havenon receives investigator-initiated research funding from AMAG Pharmaceuticals and Regeneron Pharmaceuticals.

de Havenon A, Delic A, Stulberg E, et al. Association of preeclampsia with incident stroke in later life among women in the Framingham Heart Study. JAMA Netw Open. 2021;4(4):e215077. doi:10.1001/jamanetworkopen.2021.5077