In the fourth episode of this dynamic five-part series, Dr. Hunter Hewitt and Dr. Cheryl Bushnell discuss stroke prevention in pregnancy.
Show reference:
Neurology Minute
2024 Guideline for the Primary Prevention of Stroke - Part 4
(upbeat music) - This is a continuation of our discussion of the new primary prevention of stroke guidelines with Gerald Bushnell. A major point brought up in these guidelines is stroke prevention in pregnancy. In particular, blood pressure control was a major point of discussion after a review of patients who had stroke in pregnancy. And one of the major factors that was not controlled was blood pressure. I hope you can talk to us a little bit more about this. - There is a lot of data showing that for women who are pregnant and have extremely elevated blood pressure, such as greater than 160 over 110, that there is a really high risk of developing maternal, intraceural hemorrhage that can be fatal. So our recommendation is that if a woman does have blood pressure greater than 160 over 110, that it should be lowered as soon as possible to decrease her risk of having a fatal maternal hemorrhage. And then for women who do have hypertensive disorders of pregnancy, it's really important to treat with medications to less than 140 over 90 to reduce the risk of pregnancy associated stroke. And that's probably in many cases, hemorrhage as well. And the important thing is that it's not just during pregnancy, it's the six weeks postpartum as well. And this is where primary care may end up being involved because these are women who may be outside of the realm of OB follow-up in some cases. So very important for providers to recognize women recently postpartum who have high blood pressure because they are also at risk for developing preeclampsia and the complications associated with it. - Absolutely. And as neurologists, it's definitely not uncommon that we are seeing some of these same patients for other reasons, for headache control, for epilepsy control. So knowing to keep this in mind might be very helpful. For more insight of primary stroke prevention, please read the new 2024 AHA guidelines or listen to our interview with Dr. Cheryl Bushnell in our recent neurology podcast episode. (upbeat music) (upbeat music) (upbeat music) [ Silence ]