Stroke treatment in peripartum and postpartum women: a meta-analysis and systematic review

Abstract

Pregnancy introduces unique physiological changes and conditions that can increase the risk of stroke in women. The evolving approach to investigating and managing acute stroke in pregnant patients emphasizes early intervention and tailored treatment strategies to optimize outcomes. This systematic review and meta-analysis aim to consolidate current knowledge and propose a practical approach to evaluating the efficacy and safety of revascularization therapy for acute ischemic stroke (AIS) in pregnant or post- partum individuals. Methods: This systematic review and meta-analysis encompassed original articles on stroke treatment in pregnant and postpartum women from 1990 to February 2024. English-language articles were exclusively considered, while studies before 1990, non-English articles, case studies, conference abstracts, and other non- relevant studies were excluded. The search strategy involved an extensive exploration of various databases and unpublished literature sources, including PubMed/Medline, Embase, Cochrane Library, Web of Science, Scopus, Google Scholar, and others. Methodological quality assessment was conducted independently by two reviewers using the JBIMAStARI instrument, categorizing studies into high, medium, and low-quality groups. Data collection and synthesis were performed using standardized tools, and statistical meta-analysis was employed for quantitative data synthesis, with heterogeneity assessed through various statistical tests. Results: A total of 35,816 publications were identified through electronic and manual searches, with 19,951 articles screened after removing duplicates, and 381 articles subjected to full-text assessment, resulting in three studies meeting criteria for qualitative and quantitative evaluation, as outlined in the PRISMA flow diagram. Most studies exhibited medium to high quality based on design. Results from the meta-analysis showed similar odds ratios (OR) for acute myocardial infarction (MI) with revascularization therapy in pregnant versus non-pregnant women (OR: 0.41; 95% CI: 0.01, 19.37; P=0.65). Discharge to home did not significantly differ between the two groups (OR: 0.81; 95% CI: 0.50, 1.33; P=0.41), while the risk of DVT/PTE was higher in pregnant women (OR: 4.39; 95% CI: 2.97, 6.50; P<0.001). Hospital stay duration showed a non-significant standardized mean difference (SMD) of 0.13 (95% CI: -0.01, 0.27; P=0.06). The odds of ICH following revascularization therapy did not significantly differ

between pregnant and non-pregnant groups (OR: 1.59; 95% CI: 0.25, 10.04; P=0.62), while hospital mortality and serious/life-threatening hemorrhage were lower in pregnant women (OR: 0.11; 95% CI: 0.02, 0.73; P=0.02) and similar (OR: 0.94; 95% CI: 0.13, 6.88; P=0.95), respectively.