NEW RESEARCH has shown that pregnancy is not associated with an increased long-term risk of recurrent cervical artery dissection, stroke, intracerebral haemorrhage, or death in women with a history of cervical artery dissection (CeAD), supporting the safety of future pregnancy in this population.
Cervical artery dissection is a leading cause of stroke in younger adults and occasionally arises in the context of pregnancy or the postpartum period. For women who have previously experienced CeAD, there has been clinical uncertainty regarding the safety of future pregnancies and the risk of recurrence, stroke, or major complications. This concern has led to anxiety and conservative advice in family planning, underscoring the need for robust evidence to guide counselling and care.
The LONG-RECAP study was a multicentre, registry-based cohort analysis that included 1,013 women with a confirmed history of CeAD, recruited from 33 stroke centres across nine countries between 1990 and 2023. Participants who had at least six months of follow-up and detailed records concerning subsequent pregnancies and major vascular outcomes were included. Over a median follow-up of 5.3 years, 114 women (11.3%) became pregnant after their initial CeAD, while 899 did not. The primary composite outcome—consisting of recurrent CeAD, any type of stroke, or all-cause death—occurred in 8.8% of the post-pregnancy group and 7.2% of the nonpregnancy group. There was no statistically significant difference between these groups, with an age-adjusted hazard ratio of 0.77 (95% CI, 0.38–1.56). Secondary outcomes, including the incidence of recurrent CeAD, ischaemic stroke, intracerebral haemorrhage, and death, also showed no significant differences. Notably, around half of the events in the pregnancy group took place in the postpartum period. The analysis remained consistent after adjustment for age and other confounders.
These results provide reassuring evidence that pregnancy after a prior CeAD does not confer excess risk of recurrence, stroke, or death over the longer term. From a clinical perspective, previous CeAD alone should not deter women from considering future pregnancies, and counselling can be guided by these findings to better support individualised family planning. It remains prudent to monitor patients closely during the postpartum period, but routine advice against conception is not supported by these data. Future research should continue to clarify risk profiles for subgroups and inform protocols for monitoring and management in peripartum and postpartum care.
Reference
Fischer SK et al. Long-term risk of recurrent cervical artery dissection and stroke after pregnancy. JAMA Netw Open. 2025;8(7):e2521539.
