Cerebrovascular Complications During Pregnancy

Cerebrovascular complications in pregnancy encompass both ischaemic and haemorrhagic events that arise during gestation or in the post partum period. Although the absolute incidence is low, the relative risk of stroke increases sharply around delivery and in the first weeks after childbirth. Hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, are principal drivers of endothelial dysfunction, impaired cerebral autoregulation and hypercoagulability. These pathophysiological changes predispose to small-vessel and large-artery ischaemic strokes as well as intracerebral haemorrhage. Clinical presentation varies from transient neurological deficits to catastrophic haemorrhage with high maternal and neonatal mortality. Advances in imaging, risk stratification and multidisciplinary care have begun to improve outcomes, yet significant gaps remain in early detection, guideline-based management and long-term surveillance of women at elevated risk.

Research from Nature Portfolio

In a large cohort of patients with pregnancy-associated intracerebral haemorrhage, key predictors of poor maternal outcome were identified as delayed onset-to-diagnosis interval and coexistence of preeclampsia. Surgical intervention did not confer a clear survival advantage over conservative management in this study, highlighting the need to focus on rapid recognition and optimisation of blood pressure control. The work underscored preeclampsia both as a trigger for haemorrhagic stroke and a marker of adverse maternal and neonatal prognosis.

Cerebrovascular Complications During Pregnancy publication trend

The graph below shows the total number of articles in cerebrovascular complications during pregnancy across all publications each year (not limited to Nature Index journals).

Technical terms

Preeclampsia: A hypertensive disorder of pregnancy characterised by new-onset hypertension and organ dysfunction, often involving proteinuria and endothelial injury.

Ischaemic stroke: Cerebrovascular injury caused by arterial occlusion leading to focal brain infarction.

Intracerebral haemorrhage: Bleeding into the brain parenchyma from ruptured small vessels, resulting in mass effect and neuronal injury.

Puerperium: The period of approximately six weeks following childbirth during which maternal physiology returns toward baseline.

Mendelian randomisation: A method using genetic variants as proxies for modifiable exposures to infer causal relationships in observational data.

References

1. Hypertensive disorders of pregnancy and stroke: a univariate and multivariate Mendelian randomization study. Frontiers in Endocrinology (2024).
2. Etiology and risk factors of ischemic stroke during pregnancy and puerperium: A population-based study. European Stroke Journal (2023).
3. Association of Primary Intracerebral Hemorrhage With Pregnancy and the Postpartum Period. JAMA Network Open (2020).
4. A clinical characteristic analysis of pregnancy-associated intracranial haemorrhage in China. Scientific Reports (2015).