Vascular risk factors spark rise in pregnancy-related stroke
MedWire News: US researchers have identified a large increase in the proportion of pregnant women who are hospitalized with stroke.
"I am surprised at the magnitude of the increase, which is substantial," said lead researcher Elena Kuklina (Centers for Disease Control and Prevention, Atlanta, Georgia, USA), in a press statement. "Our results indicate an urgent need to take a closer look."
The increased stroke rate was largely explained by an increasing prevalence of hypertension and heart disease, Kuklina and team report in the journal Stroke.
The team compared US Nationwide Inpatient Sample data for two periods: 1994-1995 and 2006-2007. The rate of any type of stroke in pregnant women rose between these two periods, from 0.15 to 0.22 per 1000 deliveries, or a 47% increase. The increase was even larger among women in the postpartum period, from 0.12 to 0.22 per 1000 deliveries, or an 83% increase.
There was no change in the rate of women who had stroke during delivery, at 0.27 per 1000 deliveries for both time periods.
When looking at stroke subtypes, the team noted the largest increase in pregnant women was for cerebral venous thrombosis, the rate of which almost doubled, accounting for 31% of strokes by the end of the study. For women in the postpartum period, the largest increase was for hemorrhagic stroke, which almost quadrupled in frequency, to account for 36% of postpartum strokes.
There were small increases in chronic heart disease rates over the course of the study, and large rises in hypertensive disorders, from 11.30% to 16.95% in pregnant women and 27.77% to 40.88% in postpartum women. Adjusting for these two factors rendered the increases in stroke over time nonsignificant.
These findings suggest several research directions, say Kuklina et al, including assessing the prevalence of pregnant women who require anticoagulant therapy, and gauging whether such women are managed according to current guidelines.
It is also vital to assess the effects of stroke prevention measures on fetal, neonatal, and maternal outcomes, they add.
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By Eleanor McDermid