Stroke occurs in 1 of every 2,222 pregnancy-related hospitalizations

 Be careful out there. Does this mean midwives should be used instead? Bad title. Of course the other problem is that outcomes can be worse when having a stroke in the hospital.

Stroke outcomes can be worse when they occur in hospital, Canadian study finds

Stroke occurs in 1 of every 2,222 pregnancy-related hospitalizations

Elgendy IY, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2019.10.056.
Sacco RL, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2019.11.029.

January 14, 2020

Islam Y. Elgendy

The rate of acute strokes in pregnancy-related hospitalizations did not decrease from 2007 to 2015, according to a study published in the Journal of the American College of Cardiology.
Acute stroke during pregnancy or shortly thereafter was linked to high maternal mortality, although this may be trending downward, according to the study.

See Also

• Sex differences in stroke risk factors persist
• ASA: 20 facts patients may not know about stroke
• In-hospital mortality due to acute stroke continues to decline

“In the recent years, there has been an increase in the incidence of maternal mortality rates in the United States, and cardiovascular disease is a leading cause,” Islam Y. Elgendy, MD, research fellow in medicine at Massachusetts General Hospital, told Healio. “This study evaluated the national trends of acute stroke among pregnant and postpartum women. We found that the rates of acute stroke during pregnancy have not changed or might be rising. We also found that the prevalence of most risk factors for acute stroke have been also increasing. Although, acute stroke is associated with high maternal mortality, reassuringly the rates of maternal mortality are decreasing.”
National Inpatient Sample data
Researchers analyzed data from 37,360,772 pregnancy-related hospitalizations (median age, 28 years) between January 2007 and September 2015 from the National Inpatient Sample. Information on baseline characteristics was collected including demographics and medical comorbidities.
The primary outcome was the incidence trend for acute stroke during pregnancy and the puerperium. Secondary outcomes were defined as the rates and trends of in-hospital mortality in women with stroke and the trends of risk factors for acute stroke during pregnancy.
Of the women in the study, 0.045% had an acute stroke, of which 47.2% was ischemic stroke/transient ischemic attack, 31% was hemorrhagic stroke and 21.8% was unspecified. The rate of acute stroke/TIA was largely unchanged from 42.8 per 100,000 hospitalizations in 2007 to 42.2 per 100,000 hospitalizations in 2015 (P for trend = .1), or approximately 1 for every 2,222 hospitalizations.
There was an increased prevalence in risk factors in women with acute stroke including smoking, obesity, atrial septal defects, hyperlipidemia, migraine, gestational hypertension and prior stroke. The prevalence of other traditional risk factors including diabetes and hypertension was unchanged.
Pregnant women with acute stroke/TIA had a 385-fold increased risk for in-hospital mortality compared with those without a stroke event (42.1 per 1,000 pregnancy-related hospitalizations vs. 0.11 per 1,000 pregnancy-related hospitalizations; P < .0001). In-hospital mortality rates in women with acute stroke/TIA decreased from 5.5% in 2007 to 2.7% in 2015 (P for trend < .0001).