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Acute Stroke During Pregnancy and Puerperium
Study Questions:
What is the incidence of acute stroke and transient ischemic attack (TIA) during pregnancy and up to 6 weeks after childbirth? Over time, have there been changes in incidence, risk factors, or mortality?
Methods:
The National Inpatient Sample was used to identify women in the United States with pregnancy-related hospitalizations from January 2007 to September 2015. Incidence of acute stroke/TIA and mortality were assessed over time.
Results:
Of 37,360,772 pregnancy-related hospitalizations, acute stroke occurred in 16,694 (0.45%) women. Rates of acute stroke did not change significantly between 2007 and 2015 (42.8 vs. 42.2 per 100,000 hospitalizations, respectively; p = 0.10). Among women with pregnancy-related stroke, associated conditions (obesity, smoking, hyperlipidemia, migraine, and gestational hypertension) increased over time. In-hospital mortality rates were 385-fold higher among women with pregnancy-related stroke/TIA than other pregnancy-related hospitalizations. In-hospital mortality decreased over time (5.5% in 2007 vs. 2.7% in 2015; p < 0.001).
Conclusions:
Acute stroke occurred in 1 of every 2,222 hospitalizations. There was no change in rate of stroke from 2007 to 2015. Most stroke risk factors have increased. High maternal mortality is associated with pregnancy-related stroke.
Perspective:
This study used administrative data to assess trends in pregnancy-related stroke and associated risk factors over time. Stroke occurred in 1 of every 2,222 pregnancies. Although rare overall, a significant number of women will suffer significant morbidity and mortality. Not surprisingly, hypertensive disorders were more common among women with stroke. Therefore, increased attention to diagnosing and managing high blood pressure during and after pregnancy could have a significant impact. Future studies also need to provide more detailed characterization of women with pregnancy-related stroke/TIA. For instance, specific details about the underlying comorbidities (i.e., types of congenital heart disease, cardiomyopathy, and valvular disease) and medical treatment (i.e., prophylactic or therapeutic anticoagulation) could help inform best practices for treatment of women with high-risk pregnancies. Effective methods for improving blood pressure management in vulnerable populations should be further studied. Last, this study addressed mortality, but maternal morbidity and long-term outcomes warrant further research, since stroke may be a devastating diagnosis for a young woman and her family.
Clinical Topics: Anticoagulation Management, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Vascular Medicine, Hypertension, Smoking
Keywords: Anticoagulants, Blood Pressure, Brain Ischemia, Hyperlipidemias, Hypertension, Pregnancy-Induced, Ischemic Attack, Transient, Maternal Mortality, Migraine Disorders, Obesity, Parturition, Postpartum Period, Pregnancy, Pregnancy, High-Risk, Risk Factors, Secondary Prevention, Smoking, Stroke, Vascular Diseases
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