Page 24 - RU Robert Wood Johnson Medicine • Summer 2020

60
50
40
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10
Abruption No abruption
1000
800
600
400
200
Abruption No abruption
0
15 25 35 45 55 65
Maternal age (years)
0
15 25 35 45 55 65
Maternal age (years)
To reduce that risk, he says, women should main- tain a healthy weight, eat healthfully, stop smoking, and manage their blood pressure before getting pregnant. Because research shows that managing blood pressure is vital during pregnancy, Dr. Ananth recommends that women monitor their blood pressure between prenatal appointments.
The Stroke-Abruption Link
Dr. Ananth authored a second study that looked at the risk of stroke 15 to 20 years after pregnant women experience placental
abruption, a devastating obstetric complication. In a normal pregnancy, the placenta acts as a conduit for oxygen and nutrient transfers from mother to fetus. During an abruption, the placenta partly or completely shears away from the uterus, cutting off the baby’s oxygen and nutrient supply. The fetus dies in 30 percent to 40 percent of abruption cases.
Dr. Ananth began studying placental abrup- tion while writing his doctoral thesis in 1992. Subsequently, still intrigued by the condition, he wondered how having an abruption affected women’s health in later years. He and the study’s coauthors found that in a cohort of more than 850,000 Danish women—representing 1.6 million pregnancies—those who suffered an abruption during pregnancy are at a 60 percent higher risk of death from stroke and have a 40 percent increased risk of stroke-related non-fatal compli- cations. The study, which was published in
Neurology in September 2019, also found that the earlier in the pregnancy the abruption occurred, the greater the risk of stroke. In addition, the study concludes that the risk of stroke in relation to abruption is independent of co-occurring obstetric complications.
The American Heart Association and the American College of Obstetricians and Gynecol- ogists now recommend that patients diagnosed with preeclampsia or diabetes and who deliver early should be screened for cardiovascular and stroke risks at six weeks, six months, and 12 months postpartum. However, Dr. Ananth urges that placental abruption should also be added to the list of complications that warrant screening and follow-up during women’s postpartum visits.
“Placental abruption is a serious complication that has incredible implications,” says Dr. Ananth. “Despite lots of research, we still don’t understand the etiology of the condition.”
Dr. Ananth is committed to better understand- ing the complications that face many pregnant women. He is collaborating with investigators at the Cardiovascular Institute of New Jersey at Robert Wood Johnson Medical School to look more closely at the types of cardiovascular and stroke issues associated with abruption and related complications.
“These studies provide a 30,000-foot-high view,” explains Dr. Ananth. “The next step is to dig deeper to better understand these trends and how pregnant women can reduce their risk.” M
Mortality rates
(left panel)
and non-fatal complications (right panel) from cardiovascular disease among women with and without placental abruption.
22 Robert WoodJohnson | MEDICINE
Cerebrovascular mortality per 10,000 women
Cerebrovascularmorbidity per 10,000 women