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.