Ischemic stroke recurrence during pregnancy: A case series and a review of the literature

Purpose Aims of the study were to determine the risk of stroke recurrence in a case series of women with a history of ischemic stroke and to review current available literature on this issue. Methods Charts from patients referring to the obstetrical service of our Institute were reviewed to identify pregnant women with a history of ischemic stroke. Demographic, historical and clinical data were collected from outpatient and inpatient charts. Women were contacted at least 6 months after delivery to assess maternal and neonatal health. A review of the literature regarding pregnancy in women with a history of ischemic stroke was also performed. Results Twenty-four pregnant women with a history of ischemic stroke referred to our Institution. All women received prophylaxis to prevent stroke recurrence during pregnancy. No recurrent episode was recorded in our series (0.0 %, 95% CI 0.0-11.3 %). One woman had a TIA. Considering collective data from the literature and from the present study, five cases of stroke recurrence out of 184 pregnancies were identified, corresponding to a rate of 2.7 % (95% CI 1.0-5.8 %). All of them were under prophylactic treatment at the time of stroke. Thrombophilia and preeclampsia may represent predisposing conditions for recurrence during pregnancy. Conclusions Stroke recurrence in pregnant women with a history of ischemic stroke is uncommon, but not rare and prophylactic treatment does not fully protect against it. Further evidence is required to better clarify clinical factors predisposing to recurrence.