Pregnancy, Hormonal Treatments for Infertility, Contraception, and Menopause in Women After Ischemic Stroke

Pregnancy has been reported to be associated with an increased risk of ischemic stroke, and stroke occurring during pregnancy is one of the leading causes of maternal death.1 Kuklina et al2 reported that the rate of any stroke among antenatal hospitalizations increased by 47% (from 0.15 to 0.22 per 1000 deliveries) and among postpartum hospitalizations by 83% (from 0.12 to 0.22 per 1000 deliveries) when comparing the period 1994–1995 to 2006–2007. The American Heart Association Stroke Guidelines for Women have been published recently,3 which deal with risk factors unique to women, including reproductive factors, and those factors that are more common in women, including migraine, obesity, metabolic syndrome, and atrial fibrillation. However, the lifelong management of hormonal issues in women who have had stroke was not fully addressed regarding the following: future pregnancies, type of delivery, labor induction, and secondary prevention during future pregnancy and lactation. This consensus provides multidisciplinary approaches compiled by stroke neurologists, gynecologists, and endocrinologists, based on a thorough review of current literature through computerized searches up until July 26, 2016. Literature on pregnancy, secondary stroke prevention, labor induction, hormonal contraceptive therapy, ovarian stimulation, and hormone replacement therapy was reviewed. The panel collected relevant articles using computerized searches of medical literature up until July 26, 2016. The search strategy was designed to identify studies on pregnancy, delivery, labor induction, breast-feeding, ovarian stimulation, hormonal contraceptive therapy, hormone replacement therapy, and their stroke risks. The included studies were identified from the Medline/PubMed database, EMBASE, and the Cochrane Database. Additional papers were identified from reference lists of retrieved articles, abstract lists of recent scientific meetings, and Internet-based sources (http://www.tctmd.com, http://www.cxvascular.com; Figure). Figure. Flow chart of the research strategy. A list of treatment recommendations, including evaluations of evidence strength, is provided in Table 1. View this table: Table 1. Recommendations …