Pregnancy-Related Strokes on the rise: A CDC Study

In the July 28 online issue of Stroke: Journal of the American Heart Association, researchers from the Centers for Disease Control and Prevention (CDC) reported that risk factors such as obesity and high blood pressure in women have led to a large increase in pregnancy-related strokes in the US.

Senior service fellow and epidemiologist at the CDC’s Division for Heart Disease and Stroke Prevention in Atlanta, Georgia, and lead author, Dr. Elena V Kuklina, informed the media that she was taken aback by the “substantial” increase. She urged: “Our results indicate an urgent need to take a closer look. Stroke is such a debilitating condition. We need to put more effort into prevention.”

According to Kuklina and colleagues, in the past 12 years up to 2006-07, expectant mothers and post-pregnancy women (shortly 3 months after giving birth) reported an overall increase of 54% in stroke rates.

This increase has been mainly attributed to high blood pressure and obesity.

Study data was gathered from 5-8 million discharge records of 1000 hospitals between 1994-95 and 2006-07. These data were used to understand the alterations in stroke rates of women who made hospital visits during pregnancy, during delivery, and recently after giving birth.

Kuklina and team reported the following findings:

• Over the 12 years up to 2006-07, hospitalizations for pregnancy-related strokes increased by 54% (from 4,085 to 6,293)
• Pregnancy-related strokes increased by 47% (from 0.15 to 0.22 per 1,000 deliveries)
• Post-pregnancy strokes (shortly after giving birth) increased by 83% (from 0.12 to 0.22 per 1,000 deliveries)
• Strokes during delivery remained unchanged (Consistent at 0.27 per 1,000 deliveries)
• In 2006-07, high blood pressure or heart disease was observed in nearly 32% of women hospitalized for pregnancy-related strokes and 53% of women hospitalized for post-pregnancy strokes.
• The rise in the number of hospitalizations for post-pregnancy strokes was attributed to an increased occurrence of these two conditions over the 12 years up to 2006-07.

Kuklina says that when a person is relatively healthy, the stroke risk is not that high. However, risk factors including obesity, chronic hypertension, diabetes or congenital heart disease are increasing the stroke risk in a number of women entering pregnancy.

Kuklina is of the opinion that it is best to enter pregnancy with good cardiovascular health, without additional risk factors because “pregnancy by itself is a risk factor, if you have one of these other stroke risk factors, it doubles the risk.”

She added that better guidelines must be provided to doctors and patients for monitoring and caring for women.
Kuklina said that during a literature review of this topic, she and her colleagues found only 11 cases of strokes related to pregnancy. Hence, there is a pressing need for increased research, particularly in pregnant women.
Very little information is available about drugs that can be safely prescribed to pregnant women with an increased stroke risk because pregnant women are rarely included in clinical trials due to the risk of injury to the fetus.
The CDC funded the study.

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