Pregnancy-related stroke rate rising

Be careful out there.
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Atlanta, GA - Pregnancy-related hospitalizations involving stroke have increased significantly in the US recently, researchers from the Centers for Disease Control and Prevention (CDC) have found [1].

They say this trend is due in large part to an increasing number of women with stroke risk factors such as heart disease and hypertensive disorders.

The "changing landscape" of the health of women of reproductive age is a concern; "particularly, the growing numbers of women who are entering pregnancy with increased risks for cardiovascular complications," Dr Elena V Kuklina (CDC) said in an interview.

The study was published online July 28, 2011 in Stroke and will appear in the October issue.

Stroke rate in pregnancy up 54%

Kuklina and colleagues used data from the US National Inpatient Sample from 1994 to 2007 to determine changes over time in stroke rates among pregnant women in the antenatal, delivery, and postpartum periods.

Dr Elena V Kuklina

They found that the number of pregnancy-related stroke hospitalizations grew by 54%—from 4085 in 1994-1995 to 6293 in 2006-2007.

In the antenatal period, the rate of stroke hospitalizations rose 47% (from 0.15 to 0.22 per 1000 deliveries), while in the postpartum period it rose 83% (from 0.12 to 0.22 per 1000 deliveries). The rate remained the same for strokes that occurred during the time immediately surrounding childbirth (0.27 per 1000 deliveries).

By 2006-2007, the overall prevalence of pregnancy-related stroke hospital admissions was 0.71 per 1000 delivery hospitalizations.

For the period 2006-2007, cerebral vascular thrombosis was the most common stroke subtype in the antenatal period (31%) and the delivery period (43%), whereas hemorrhagic stroke was the most common type in the postpartum period (36%).

In 2006-2007, roughly 32% of antenatal and 53% of patients admitted in postpartum hospitalizations involving stroke had concurrent hypertensive disorder or heart disease. Increases in the prevalence of these two conditions from the mid-1990s to the mid-2000s explained nearly all of the increase in postpartum hospitalizations with stroke during this period, the researchers say.

More attention to heart health

"From other studies," Kuklina commented, "we also know that the prevalence of diabetes, obesity, inherited hypercoagulable states, thrombophilia, antiphospholipid antibody syndrome, prothrombin gene mutation, or factor V Leiden is also increasing among pregnant women.

"We should not overlook the problem of cardiovascular disease among young adults," she said. "Regardless of their pregnancy status, we should use an opportunity when we see young women in clinical practice to estimate their risks of cardiovascular disease and discuss lifestyle changes to improve cardiovascular health."

Dr Sung-Chun Tang (Taiwan University, Taipei), who was not involved in the study, agrees. The results of this analysis provide "an important message for clinical physicians; more attention should be paid to stroke in pregnant women," Tang said.

"Another major concern," Kuklina said, "is that despite the fast-growing population of pregnant women who are at risk for stroke, very limited data exist on preventive treatment of stroke in pregnancy and the treatment of acute stroke in pregnancy.

"Currently, no randomized controlled clinical trials to guide decisions in clinical practice are available. Although recommendations on the preventive treatment of stroke in pregnancy are available, they vary among medical organizations," she added.