Sells Christina Mijalski, Feske Steven K
Department of Neurology, Stanford University Medical Center, Stanford Stroke Center, Palo Alto, California.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Semin Neurol. 2017 Dec;37(6):669-678. doi: 10.1055/s-0037-1608940. Epub 2017 Dec 21.
Pregnancy and the postpartum period confer an increased risk of stroke. The risk appears to be increased for all strokes during the puerperium and for hemorrhagic strokes during pregnancy. During pregnancy, physiologic systems are under increased stress to accommodate the growing fetus, which results in substantial hemodynamic, cardiovascular, hematologic, immunologic, and structural connective tissue changes that account for much of this increased risk. In addition, preeclampsia-eclampsia has major effects on the vascular system, and this disorder, unique to pregnancy, is another major contributor to this risk. The common independent vascular risk factors for stroke, such as hypertension, diabetes, hyperlipidemia, and smoking, may also be present to contribute to the risks conferred by pregnancy. Though uncommon, stroke during pregnancy and in the postpartum period causes substantial morbidity and mortality in affected women, and it poses a significant risk to the fetus. This review will discuss the epidemiology of pregnancy-associated stroke, specific risk factors and mechanisms, clinical presentation and management, and future directions.
怀孕和产后时期会增加中风风险。产褥期所有类型中风以及孕期出血性中风的风险似乎都会增加。孕期生理系统承受着越来越大的压力来适应不断成长的胎儿，这导致了显著的血流动力学、心血管、血液学、免疫学和结构性结缔组织变化，这些变化是导致风险增加的主要原因。此外，先兆子痫 - 子痫对血管系统有重大影响，这种妊娠特有的疾病是导致该风险的另一个主要因素。中风常见的独立血管危险因素，如高血压、糖尿病、高脂血症和吸烟，也可能存在并增加妊娠带来的风险。尽管不常见，但孕期和产后中风会给受影响的女性带来相当高的发病率和死亡率，并且对胎儿构成重大风险。本综述将讨论妊娠相关中风的流行病学、特定危险因素和机制、临床表现与管理以及未来方向。
