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Stroke

Stroke & Pregnancy

08/06/2007

Question:

I am 29 years old & had a stroke when I was 18. I spent a fortnight in hospital undergoing numerous tests to determine the cause & in the end, doctors put it down to the fact I was on the pill. Subsequently I haven`t taken the pill since & have had a Mirena IUD inserted, which works exceptionally well. My husband & I are now considering starting a family.

I recently had an ankle operation & my anesthetist was most intrigued about my stroke & my young age & asked if I`d had a family. When I told him no he mentioned I could face a few problems in that during pregnancy there`s a high risk of a stroke reoccurring due to certain hormones in the body. I wasn`t thinking too straight about this (as I was waiting for ankle surgery!) so I kind`ve dismissed his comment. But post surgery, it`s got me thinking. Can you shed any light on this or direct me to some reading material?

Many thanks for your assistance.

Answer:

I’m not sure exactly where your doctor was going with this comment, but here are a few thoughts. The data about oral contraceptive medications, hormones, and stroke are scarce. The best data suggest that there is a very slight increase in risk for stroke while taking oral contraceptive pills, but again this risk is very low. However, if you have other stroke risk factors, the risk might be increased in combination. For example, in one study women who were taking oral contraceptives and smoking had up to a 10-fold increase in risk for stroke.

Alternatively, your doctor might have been wondering if you’ve ever been evaluated for a hypercoagulable state (a predisposition to forming blood clots). This is a potential cause of stroke in young people, and can be associated with problems during pregnancy. You might look up the antiphospholipid antibody syndrome; this is a syndrome where women can have blood clotting problems (an excessive risk of blood clots in legs, lungs, brain, etc.) as well as risk for complications during pregnancy.

I would advise you to speak with your primary care doctor, your neurologist (if you have one), and your obstetrician before trying to get pregnant. You could ask them about these issues, and they could counsel you about your potential risk.

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati