Maternal Preeclampsia Associated With Increased Risk of Stroke in Offspring

Mild preeclampsia and late-developing preeclampsia were not found to increase risk of stroke as much as early-stage.

Maternal preeclampsia can increase risks of ischemic heart disease (IHD) and stroke in offspring. Familial, environmental, and genetic factors, and developmental programming, may be contributing factors. Specifically, the risk of IHD in offspring who were exposed to preeclampsia was 33% in Nordic populations, while the risk of stroke in this population was even greater at 34%.

“Maternal preeclampsia and other hypertensive disorders of pregnancy were associated with increased risks of IHD and stroke in the offspring,” wrote study authors in a report published in JAMA Network Open.

The study authors explained that the main objectives of their study were to evaluate an association between maternal preeclampsia with risk of IHD and stroke in the offspring, if the onset of preeclampsia is associated with severity or timing, and the role of preterm birth and small for gestational age (SGA) birth.

Preeclampsia is a placenta-related complication associated with cardiovascular risk factors during childhood and early adulthood, risk factors include diabetes and hypertension.

However, data have not established whether cardiovascular diseases (CVDs)—which cause nearly 33% of all deaths (IDH and stroke being the 2 main CVDs to cause death)—share an association with preeclampsia, which affects 3% to 5% of pregnant women.

“It is plausible that early- and late-onset preeclampsia have different outcomes given that they are 2 distinct entities, but few studies have investigated whether the risk of IHD and stroke differs according to the timing of onset or severity of preeclampsia,” study authors wrote.

Based on this and other knowledge gaps in the literature, researchers in Denmark, Finland, and Sweden compiled Medical Birth Registers from 1973 in a population-based cohort study. They used sibling analysis to analyze data from a cohort of 8,475,819 births.

The resulting data showed that 2.2% of total offspring were exposed to maternal preeclampsia. Further, 7446 were diagnosed with IHD and 10,918 were diagnosed with stroke during follow-up.

While there was an association between risk of preeclampsia and stroke or IHD in offspring, “these associations were largely independent of preterm or SGA birth,” study authors wrote in the report.

Yet for offspring with all 3 risk factors (preeclampsia, preterm birth, and SGA) their risk of stroke was 198% higher than individuals without any 1 of these risk factors. Furthermore, offspring exposed to maternal preeclampsia had a greater likelihood of preterm birth than normal offspring.

Mothers were also more likely to be “nulliparous, [obese], single, a nonsmoker, and have a family history of CVDs,” study authors wrote in the report.

Additionally, risk of stroke was greater in severe or early-onset preeclampsia. Risk of stroke was worsened by SGA birth as well, as compared to milder preeclampsia.

The study authors noted that the study contains some limitations, including the generalization of results to children or young adults. Additionally, preeclampsia has various definitions and may be misclassified. Study authors also addressed residual confounding with analysis that contains design limitations, and statistical power could also be limited.

“Screening for risk factors among offspring born to individuals with preeclampsia and primary preventive measures may be implemented early in life to reduce the burden of CVDs,” study authors wrote in the report.

Reference

Yang, Fen, Janszky, Imre, Gissler, Mika, et al. Association of Maternal Preeclampsia With Offspring Risks of Ischemic Heart Disease and Stroke in Nordic Countries. JAMA Netw Open. 2022;5(11):e2242064. doi:10.1001/jamanetworkopen.2022.42064