Neurology CP:颈动脉夹层后是否可以怀孕?

2022-01-21 杨中华 “脑血管病及重症文献导读”公众号

颈动脉夹层(Cervical artery dissection,CAD)是年轻人卒中的主要原因。CAD复发呈双峰分布,主要发生在初始事件后的第一个月,而晚期复发的风险较低(每年1%)。

颈动脉夹层(Cervical artery dissection,CAD)是年轻人卒中的主要原因。CAD复发呈双峰分布,主要发生在初始事件后的第一个月,而晚期复发的风险较低(每年1%)。

文献报道显示一些 CAD 发生在妊娠或产褥期女性,这表明妊娠或产褥期可能是危险因素。最近一项针对大量女性人群样本的分析表明,妊娠与高风险的CAD相关产褥期,定义为分娩后约6周,似乎是风险最高的时期,占CAD的6%用力分娩有关的机械因素、激素变化引起的动脉壁短暂异常、生理性血液动力学变化(如心流量或血容量增加)或继发性高血压(先兆子痫或溶血、肝酶升高和低血小板[HELLP]综合征)可能起到了一定作用

关于妊娠和分娩期间复发风险的研究很少,由于缺乏观察数据,因此很难在这方面为患有CAD且希望怀孕的妇女提供可靠的建议。分娩方案是否有效果也尚不清楚。只有一项研究专门评估过这一风险,并指出妊娠、分娩或产褥期不会增加这一风险。

2021年12月来自法国的Benoit Guillon等在Neurology: Clinical Practice上公布了他们的研究结果,目的在于评估患有CAD病史的妇女在妊娠期和产褥期复发颈动脉夹层(CAD)的风险,然后帮助医生向希望怀孕的妇女提供医疗信息。

研究者从医院数据库中确定了2005年至2017年间因CAD入院的16-45岁女性,包括自发性和症状性CAD患者。然后联系他们回答一份专门设计的关于CAD复发和原发性CAD后怀孕的问卷。

91名患者符合我们的纳入标准,89名患者被纳入分析。在7.0年的中位随访期间,4名妇女(4.4%)发生了复发性CAD,都未发生在妊娠或产褥期。18名妇女(20%)共有20次足月妊娠,这些妊娠皆发生在CAD后至少6个月。在这20例妊娠中,13例(65%)为阴道分娩,7例(35%)为剖宫产。在89%的病例中,CAD后未怀孕的原因与血管事件无关,但8%的妇女曾被医生建议避免未来怀孕,或被建议进行流产或绝育。

最终作者认为,在这项研究中,无论分娩类型如何,在随后的妊娠或产后没有CAD复发。因此,有CAD病史的妇女怀孕似乎是安全的。

原始出处:

Myriam Assif, Catherine Lamy, Solène De Gaalon, et al. Cervical Artery Dissection in Young Women Risk of Recurrence During Subsequent Pregnancies. Neurology:Clinical Practice, 2021.

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