Steep Rise in Pregnancy-Related Strokes in the United States

A new study reports a large increase in pregnancy-related strokes in the United States, mainly due to higher numbers of women with risk factors such as obesity and high blood pressure.

Researchers at the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) analyzed hospital discharge data obtained from the nationwide inpatient sample on 8 million discharge records from 1,000 hospitals, covering the period 1994-95 to 2006-07. Pregnancy-related hospitalizations with stroke (subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, transient ischemic attack [TIA], cerebral venous thrombosis, or unspecified) were identified according to the International Classification of Diseases, and rates of strokes in women were calculated for the women during pregnancy, during delivery, and recently after giving birth.

The results showed the rate of any stroke among antenatal hospitalizations increased by 47% (from 0.15 to 0.22 per 1,000 deliveries) during the period, and among postpartum hospitalizations by 83%, while remaining unchanged at 0.27 for delivery hospitalizations. In 2006-2007, 32% and 53% of antenatal and postpartum hospitalizations with stroke, respectively, had concurrent hypertensive disorders or heart disease. Changes in the prevalence of these two conditions over the years explained almost all of the increase in postpartum hospitalizations with stroke during the same period. The study was published in the July 28, 2011, online issue of Stroke.

“Since pregnancy by itself is a risk factor, if you have one of these other stroke risk factors, it doubles the risk, so it is best to enter pregnancy with good cardiovascular health, without additional risk factors,” said lead author epidemiologist Elena Kuklina, MD, PhD, of the CDC's division for heart disease and stroke prevention. “We need to give doctors and patients better guidelines for monitoring and caring for women before, during, and after childbirth.”

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US Centers for Disease Control and Prevention