The Doctor Is In!
Welcome to a new feature from PREG where our doctors weigh in on a variety of fertility-related issues designed just for you!
Dr. Karenne Fru, MD, PhD
Reproductive Endocrinologist
Answers questions about Stroke Factors and Risks
Dr. Fru, Do young, seemingly healthy women have to worry about having a stroke?
The short answer is, yes they do. The reason is there is a category of women who suffer from what is called a cryptogenic stroke. These women will have no identifiable risk factors and yet will suffer a stroke. A young stroke survivor is under the age of 50, but younger reproductive age women need to be aware of stroke risks.
What are the signs/symptoms of a stroke?
The American Heart Association has developed a good acronym to assess a possible stroke. F.A.S.T.
- Facial droop limited to one side
- Arm or limb weakness or leg
- Speech-difficulty communicating or understanding their speech
- Time-take a look at the time and call 911
If you have facial drooping, arm weakness, or difficulty talking it’s time to call 911.
Facial drooping evolves fairly quickly especially if it is an ischemic stroke, which is one from a blood clot. It blocks off a vessel causing immediate neurologic symptoms. However, if it is a hemorrhagic stroke (a blood vessel bleed) the symptoms can be expedited and progressive.
What are some of the risk factors for stroke?
We look at several factors such as if they have a family history of cardiovascular problems, high blood pressure, and stroke. Obesity is a big contributor to the risk of high blood pressure and diabetes.
Also, a recent exposure to estrogen, which can be the case for women on birth control, a recent pregnancy, or hormonal replacement therapy and certain genetic risk factors. If you have an underlying risk for clotting, estrogen exposure such as in pregnancy can trigger a clotting event.
You seem to be very passionate about this topic?
One of my goals is to speak out on this topic because many young women do not realize they are at risk for a stroke because they are relying on their age, or they don’t have some of the high-risk factors. Cryptogenic strokes do not require any pre-existing conditions. This is an area of research being pursued by scientists and the American Heart Association.
When I had my stroke, I was 32 yrs old. I want women to know that a stroke is largely survivable. However, there are secondary factors living as a stroke survivor because it impacts the brain. There can be changes in personality, speech, long and short term memory, the ability to walk and a loss of energy. I had to learn to relearn speech, how to walk and use my hands to write. It takes a lot of physical, speech and occupational therapy. I’m lucky that I don’t have any long-term side effects.
Stroke and cardiac issues present differently in women than in men. Because the symptoms are different many young women tend to ignore them. Young women often think they can write it off, but time is critical and certain clot-busting medication can only be used if you arrive at the Emergency Room within certain time constraints and the earlier you respond the better the outcomes.
Tell us about stroke survivors and fertility in regard to treatment?
You require a multidisciplinary approach throughout your pregnancy. Everyone needs to be on board from hematology/oncology and you must be discharged from neurology. You need a really good support system depending on your stroke deficits. You may also need to re-enrol in physical therapy because of balance issues during pregnancy which can be challenging under normal circumstances.
Stroke recovery is a lot easier the younger you are because there is more plasticity in the brain to allow for a quicker recovery. The brain can reroute signals around the area of injury within two years and achieve 80%completion. If any long-lived deficits present at the end of that two year period and within that time we establish a mechanism by which you had said stroke (whether a DVT, became a clot to brain—or evaluated for a hole in the heart,) and addressed it or if you had a non-repeating cause of stroke, then in consultation with hematology while trying to get pregnant some type of anticoagulant would be used. If you were diagnosed with a clotting disorder a higher dose of blood thinners would be used. In pregnancy, a couple of the anticoagulants that have been approved are low molecular weight Heparin and unfractionated Heparin. Tight control of high blood pressure is also encouraged to mitigate risks of a secondary stroke.
The two Heparin anticoagulants have a lot more evidence of safety in pregnancy. Coumadin has known pregnancy birth defects, but newer drugs have little evidence of people being on them and being pregnant so we have to wait and see the research results over time. MI’s, stroke or other cardiac complications can be managed. We go off the rails so to speak when they have unplanned pregnancies. After delivery, if you were on Xarelto/Eliquis prior to pregnancy, you would be switched to some form of Heparin through the rest of the breastfeeding period. It doesn’t seem to increase the risk of birth defects but more importantly, the mothers get to live.
What About Risks for stroke during pregnancy?
There are BP complications of pregnancy that can increase your risk for stroke, preeclampsia, or pro coagulation. During pregnancy, there is way more estrogen in the body making it more likely to form blood clots. If you have an undiagnosed blood clot and get pregnant you are more likely to have a second blood clot. The health of the mother will determine how well a baby tolerates this. Anytime we are losing blood flow to the brain the body tries to compensate and might compromise blood flow to other organs. So the baby is at risk. Depending on how far along the pregnancy is we can effect a delivery, get the baby out and focus on treating the mom.
PREG has offices in Greenville, Spartanburg, Asheville, and Columbia. We offer highly personalized fertility care and management. Dr. Fru is based at the Columbia, SC, office. For more information on reproductive options call, or contact us today at 866.725.7734, or online at https://www.pregonline.com/contact-us.php
Dr. Karenne Fru, MD, Ph.D.
Reproductive Endocrinologist
