Etiopathogenetic risk factors for stroke in pregnant women
https://doi.org/10.17749/2313-7347.2019.13.3.217-226
Abstract
Stroke is a severe thrombotic condition that can occur in women of reproductive age during their pregnancy. Physiological changes that occur during gestation, childbirth and the postpartum period predispose a woman to the development of thrombotic complications. However, the true causes of cerebrovascular accidents are not fully understood. More than 50 % of strokes occur in the absence of obvious risk factors. The article reviews etiological and pathogenetic mechanisms of cerebral blood flow disorders and factors contributing to this condition in pregnant women.
About the Authors
E. A. Bayanduryan
Kuban State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Emmanuela A. Bayanduryan – Obstetrician, Gynecologist, Graduate Student, Department of Obstetrics, Gynecology and Perinatology
4 Mitrofana Sedina St., Krasnodar 350063
N. V. Samburova
Sechenov University
Russian Federation
Russian Federation
Natalya V. Samburova – PhD, Associate Professor, Department of Pathophysiology, Institute of Clinical Medicine
8/2 Trubetskaya St., Moscow 119991
E. V. Anichkova
Sechenov University
Russian Federation
Russian Federation
Elizaveta V. Anichkova – 4 th year student, International School “Medicine of the Future”
8/2 Trubetskaya St., Moscow 119991
A. S. Shkoda
City Clinical Hospital № 67 named after L.A. Vorokhobov, Moscow City Healthcare Department
Russian Federation
Russian Federation
Andrey S. Shkoda – MD, PhD, Professor, Chief Physician
2/44 Salyama Adilya St., Moscow 123423
V. O. Bitsadze
Kuban State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Victoria O. Bitsadze – MD, PhD, Professor, Department of Obstetrics and Gynecology, Institute of Children's Health
Scopus Author ID: 6506003478
4 Mitrofana Sedina St., Krasnodar 350063
References
1. Kulikov A.Yu., Zinchuk I.Yu. Pharmacoeconomic analysis of neuroprotective drugs in the treatment of acute disorders of cerebral curculation. [Farmakoekonomicheskij analiz nejroprotektivnyh lekarstvennyh sredstv v lechenii ostrogo narusheniya mozgovogo krovoobrashcheniya]. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya. 2013;6(3):17–22. (In Russ.).
2. Mikheeva N.V., Reshetko O.V., Ryzhenkova I.G. Pharmacoepidemiology of stroke treatment in different hospitals. [Farmakoepidemiologiya lekarstvennyh sredstv, primenyaemyh dlya lecheniya infarkta mozga, v stacionarah razlichnogo tipa]. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya. 2013;6(4):35–37. (In Russ.).
3. Dombrovskiy V.S., Omelyanovskiy V.V. Problems of outcomes choice for the assessment of rehabilitation programs efficiency in patients after stroke and craniocerebral injury. [Problemy vybora iskhodov dlya ocenki effektivnosti programm reabilitacii bol'nyh posle insul'ta i ChMT]. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya. 2014;7(3):20–5. (In Russ.).
4. Gnezditskiy V.V., Korepina O.S., Karlov V.A. et al. EEG and event-related potential (P300) in elderly patients with aphasia and epilepsy after a stroke. [Komp'yuternaya EEG i kognitivnye vyzvannye potencialy u pozhilyh bol'nyh s afaziej i epilepsiej posle insul'ta]. Epilepsiya i paroksizmal'nye sostoyaniya. 2016;8(1):12–21. (In Russ.). DOI: 10.17749/2077-8333.2016.8.1.012-021.
5. Akhvlediani K.N., Logutova L.S., Travkina A.A. et al. Ischemic stroke and pregnancy. [Ishemicheskij insul't i beremennost']. Rossijskij vestnik akushera-ginekologa. 2015;15(6):65–71. (In Russ.). DOI: 10.17116/rosakush201515665-71.
6. Treadwell S.D., Thanvi B., Robinson T.G. Stroke in pregnancy and the puerperium. Postgrad Med J. 2008;84(991):238–45. DOI: 10.1136/pgmj.2007.066167.
7. Davie C.A., O’Brien P. Stroke and pregnancy. J Neurol Neurosurg Psychiatry. 2008;79(3):240–245. DOI:10.1136/jnnp.2007.116939.
8. Treatment and prevention of cerebrovascular disorders during pregnancy. Stroke in obstetrics. III Russian International Congress "Cerebrovascular Pathology and Stroke". [Lechenie i profilaktika cerebrovaskulyarnyh rasstrojstv v period beremennosti. Insul't v akusherstve. III Rossijskij mezhdunarodnyj kongress «Cerebrovaskulyarnaya patologiya i insul't»]. Effektivnaya farmakoterapiya. 2015;(1):52–6. (In Russ.).
9. Scott C.A., Bewley S., Rudd A. et al. Incidence, risk factors, management, and outcomes of stroke in pregnancy. Obstet Gynecol. 2012;120(2 Pt 1):318–24. DOI: 10.1097/AOG.0b013e31825f287c.
10. Arustamyan R.R., Adamyan L.V., Shifman E.M., Ovezov A.M. Acute cerebrovascular accidents in pregnancy, labor and postpartum. [Ostrye narusheniya mozgovogo krovoobrashcheniya vo vremya beremennosti, rodov i v poslerodovom periode]. Al'manah klinicheskoj mediciny. 2016;44(3):295–300. (In Russ.). DOI: 10.18786/2072-0505-2016-44-3-295-300.
11. Laskov V.B. The risk factors and mechanisms for development of stroke and its types during pregnancy and the possibilities of medical therapy. [Faktory riska, mekhanizmy razvitiya i vidy insul'ta pri beremennosti. Vozmozhnosti medikamentoznoj terapii]. Nevrologiya, nejropsihiatriya, psihosomatika. 2013;(3):71–7. (In Russ.).
12. Szolnoki Z., Somogyvari F., Kondacs A. et al. Evaluation of the roles of the Leiden V mutation and ACE I/D polymorphism in subtypes of ischaemic stroke. J Neurol. 2001;248(9):756–61. DOI: 10.1007/s004150170090.
13. Camargo E.C., Feske S.K., Singhal A.B. Stroke in pregnancy: an update. Neurol Clin. 2019;37(1):131–48. DOI: 10.1016/j.ncl.2018.09.010.
14. Yoshida K., Takahashi J.C., Takenobu Y. et al. Strokes associated with pregnancy and puerperium: a nationwide study by the Japan Stroke Society. Stroke. 2017;48(2):276–82. DOI: 10.1161/STROKEAHA.116.014406.
15. Krasnopolsky V.I., Logutova L.S., Akhvlediani K.N. et al. Cerebrovascular diseases and pregnancy. [Cerebrovaskulyarnye zabolevaniya i beremennost']. Akusherstvo i ginekologiya. 2017;(8):50–8. (In Russ.). DOI: 10.18565/aig.2017.8.50-8.
16. Avdey G.M., Dyurd T.I. Cerebrovascular pathology and insult. [Cerebrovaskulyarnaya patologiya i insul't]. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta. 2003;(4):14–9. (In Russ.).
17. Drobinskaya A.N., Popova T.F., Marushchak A.A. Hemorrhagic stroke and pregnancy. Proceedings of the III International Congress "New technologies in obstetrics, gynecology, perinatology and reproductive medicine." Eds. N.M. Pasman, M.Yu. Denisov. [Gemorragicheskij insul't i beremennost'. Sbornik trudov III Mezhdunarodnogo kongressa «Novye tekhnologii v akusherstve, ginekologii, perinatologii i reproduktivnoj medicine». Pod red. N.M. Pasman, M.Yu. Denisova]. Novosibirsk: Izd-vo «Klinika professora Pasman», 2017. 95–101. (In Russ.).
18. Feske S.K. Stroke in pregnancy. Semin Neurol. 2007;27(5):442–52. DOI: 10.1055/s-2007-991126.
19. Shifman E.M., Kulikov A.V. Stroke during pregnancy, childbirth and the puerperium. Project of clinical guidelines. [Insul't vo vremya beremennosti, rodov i poslerodovogo perioda]. Proekt klinicheskih rekomendacij]. 2014. 9 s. (In Russ.). Available at: http://www.arfpoint.ru/wp-content/uploads/2014/06/26_insult-vo-vremyaberemennosti-rodov-i-poslerodovogo-perioda.pdf.
20. Sells C.M., Feske S.K. Stroke in pregnancy. Semin Neurol. 2017;37(06):669–78. DOI: 10.1055/s-0037-1608940.
21. Ros H.S., Lichtenstein P., Bellocco R. et al. Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified? Am J Obstet Gynecol. 2002;186(2):198–203. DOI: 10.1067/mob.2002.119177.
22. Taitubayeva G.K., Gribacheva I.A., Petrova E.V., Popova T.F. Stroke and pregnancy: the main risk factors. [Insul't i beremennost': osnovnye faktory riska]. Issledovaniya i praktika v medicine. 2017;4(4):27–34. DOI: 10.17709/2409-2231-2017-4-4-3. (In Russ.).
23. Mutsaeva Z.D. Peculiarities of pregnancy and childbirth in multiparous women. [Osobennosti techeniya beremennosti i rodov u mnogorozhavshih zhenshchin]. Zhurnal ROAG. 2009;(2):16–22. (In Russ.).
24. Girot M. Smoking and stroke. Presse Med. 2009;38(7–8):1120–5. DOI: 10.1016/j.lpm.2008.12.018.
25. Liew B.S., Ghani A.A., You X. Stroke in pregnancy. Med J Malaysia. 2019;3(74):246–9.
26. Brynkova I.V., Dzhemilov I.V. Pathophysiology of ischemic stroke in pregnant women. [Patofiziologiya ishemicheskogo insul'ta u beremennyh. I Studencheskaya nauchno-teoreticheskaya konferenciya, posvyashchennaya 120-letiyu so dnya rozhdeniya S.I. Georgievskogo «Aktual'naya medicina»: tezisy dokladov]. Simferopol': Izd-vo KFU im. V.I. Vernadskogo, 2018. 417–20. (In Russ.).
27. Fernandes S.M., Arendt K.W., Landzberg M.J. et al. Pregnant women with congenital heart disease: cardiac, anesthetic and obstetrical implications. Expert Rev Cardiovasc Ther. 2010;8(3):439–48. DOI: 10.1586/erc.09.179.
28. Wiebers D.O. Ischemic cerebrovascular complication of pregnancy. Arch Neurol. 1985;42(11):1106–13.
29. Menke J., Lüthje L., Kastrup A. et al. Thromboembolism in atrial fibrillation. Am J Cardiol. 2010;105(4):502–10. DOI: 10.1016/j.amjcard.2009.10.018.
30. Overell J.R., Bone I., Lees K.R. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55(8):1172–9. DOI: 10.1212/wnl.55.8.1172.
31. Lalouschek W., Schillinger M., Hsieh K. et al. Matched case-control study on factor V Leiden and the prothrombin G20210A mutation in patients with ischemic stroke/transient ischemic attack up to the age of 60 years. Stroke. 2005;36(7):1405–9. DOI: 10.1161/01.
32. Makatsariya A.D., Bitsadze V.O., Blinov D.V., Korabelnikov D.I. Information on the combined hormonal contraceptives (CHC) containing the dienogest + ethinyl estradiol combination (Jeanine ® ). [Informaciya o kombinirovannyh gormonal'nyh kontraceptivnyh preparatah (KGK), soderzhashchih kombinaciyu dienogest + etinilestradiol (lekarstvennyj preparat Zhanin®). Akusherstvo, ginekologiya i reprodukciya. 2019;13(1):7–12. (In Russ.). DOI: 10.17749/2313-7347.2019.13.1.007-012.
33. McDermott M., Miller E.C., Rundek T. et al. Preeclampsia: association with posterior reversible encephalopathy syndrome and stroke. Stroke. 2018;3(49):524–30. DOI: 10.1161/STROKEAHA.117.018416.
34. Shapovalova O.A., Novikova V.A., Olenev A.S. Gestationally conditioned presupposition for maternal cerebrovascular disorders. [Gestacionno obuslovlennye predposylki dlya materinskogo narusheniya mozgovogo krovoobrashcheniya]. Prakticheskaya medicina. 2018;(6):77–84. (In Russ.).
35. Sanders B.D., Davis M.G., Holley S.L. et al. Pregnancy-associated stroke. J Midwifery Womens Health. 2018;63(1):23–32. DOI: 10.1111/jmwh.12720.
36. Kapanadze D.L., Diakonidze T.A., Zubenko V.B. Role of genetic thrombophilia in the development of thromboembolic and obstetric complications. [Rol' geneticheskoj trombofilii v razvitii tromboembolicheskih i akusherskih oslozhnenij]. Akusherstvo, ginekologiya i zeprodukciya. 2017;11(4):68–71. (In Russ.). DOI: 10.17749/2313-7347.2017.11.4.068-071.
37. Malyshkina A.I., Fetisova I.N., Zholobov Yu.N. et al. Polymorphism of the haemostasis genes in women with threatened preterm delivery. [Polimorfizm genov sistemy gemostaza u zhenshchin s ugrozhayushchimi prezhdevremennymi rodami]. Akusherstvo, ginekologiya i reprodukciya. 2018;12(1):23–33. DOI: 10.17749/2313-7347.2018.12.1.023-033. (In Russ.).
38. Coppola A., Tufano A., Cerbone A.M. et al. Inherited thrombophilia: implication for prevention and treatment of venous thromboembolism. Semin Thromb Hemost. 2009;35(7):683–94. DOI: 10.1055/s-0029-1242722.
39. Makatsariya A.D., Akinshina S.V., Bitsadze V.O. et al. Pregnancy in women with history of ischemic stroke and thrombophilia. [Beremennost' u zhenshchin s ishemicheskim insul'tom i trombofiliej v anamneze]. Akusherstvo, ginekologiya i reprodukciya. 2015;9(2):89–98. (In Russ.). DOI: 10.17749/2070-4968.2015.9.2.089-098.
40. Krivonos M.I., Zainulina M.S., Selkov S.A. Antiphospholipid syndrome and early reproductive failure. [Antifosfolipidnyj sindrom i rannie reproduktivnye poteri]. Akusherstvo, ginekologiya i reprodukciya. 2016;10(4):114–22. (In Russ.). DOI: 10.17749/2313-7347.2016.10.4.114-122.
41. Bitsadze V.O., Khizroeva D.Kh., Idrisova L.E. et al. Catastrophic antiphospholipid syndrome. Pathogenesis issues. [Katastroficheskij antifosfolipidnyj sindrom. Voprosy patogeneza]. Akusherstvo, ginekologiya i reprodukciya. 2015;9(2):32–53. (In Russ.). DOI: 10.17749/2070-4968.2015.9.2.032-053.
42. Sukontseva T.A., Kaplina O.Yu. On the pathogenesis of thrombosis in antiphospholipid syndrome. [K voprosu o patogeneze trombozov pri antifosfolipidnom syndrome]. Akusherstvo, ginekologiya i reprodukciya. 2018;12(3):72–8. (In Russ.). DOI: 10.17749/2313-7347.2018.12.3.072-078.
43. Akinshina S.V., Bitsadze V.O., Gadaev Z.K., Makatsariya A.D. Thrombotic microangiopathy in the pathogenesis of obstetric complications. [Znachenie tromboticheskoj mikroangiopatii v patogeneze akusherskih oslozhnenij]. Akusherstvo, ginekologiya i reprodukciya. 2015;9(2):62–71. (In Russ.). DOI: 10.17749/2070-4968.2015.9.2.062-71.
44. Denorme F., Kraft P., Pareyn I. et al Reduced ADAMTS13 levels in patients with acute and chronic cerebrovascular disease. PLoS One. 2017;12(6):e0179258. DOI: 10.1371/journal.pone.0179258.
Review
For citations:
Bayanduryan E.A., Samburova N.V., Anichkova E.V., Shkoda A.S., Bitsadze V.O. Etiopathogenetic risk factors for stroke in pregnant women. Obstetrics, Gynecology and Reproduction. 2019;13(3):217-226. (In Russ.) https://doi.org/10.17749/2313-7347.2019.13.3.217-226
Views:
1296
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
