By Matthew E. Fink, MD
Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, New York Presbyterian/Weill Cornell Medical College
SOURCE: Liang C, Chung HF, Dobson AJ, Mishra GD. Infertility, miscarriage, stillbirth, and the risk of stroke among women: A systematic review and meta-analysis. Stroke 2022;53:328-337
Sex-related differences exist in stroke burden, and although men have a higher incidence rate than women, more women have strokes, in terms of absolute numbers, and experience worse outcomes. Well-recognized risk factors include hypertension, diabetes, cardiac disorders, and elevated cholesterol, but these do not explain the differences in stroke risk between men and women.
There have been limited studies looking at the effect of miscarriage and stillbirth, which could have an effect on endothelial function and chronic systemic inflammation, conditions that play a role in the long-term risk of stroke. These investigators performed a comprehensive literature search and meta-analysis of 16 cohort studies and two case-control studies that reviewed the records of 7,808,521 women who experienced complications around pregnancy to determine the subsequent risk of stroke.
The investigators determined that women who had experienced miscarriage or stillbirth were at a higher risk of future stroke, with a hazard ratio of 1.07 for miscarriage and 1.38 for stillbirth. Repeated events of stillbirth or miscarriage further increased the hazard ratio. There were no statistically significant effects of infertility on future stroke. The study investigators concluded that miscarriage and stillbirth are risk factors for future stroke in women and are unique to women.
