Stroke a Growing Concern for Women in Pregnancy

With increasing rates of women at high risk for stroke due to obesity, congenital heart disease, and autoimmune disorders, there is a growing concern about stroke during pregnancy. In fact, the World Health Organization (WHO) has chosen stroke during pregnancy and the postpartum period as an area of special interest; WHO is considering labeling stroke as a life-threatening obstetric complication and as a condition that may make unintended pregnancy an unacceptable health risk. To better understand this risk, Dr Elena V. Kuklina, epidemiologist in the division for heart disease and stroke prevention at Centers for Disease Control and Prevention, and colleagues analyzed data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project.

Kuklina and colleagues found that hypertensive disorders were common among patients, with the rates of hypertensive disorders increasing with time (Figure). They further found that strokes increased between 1994-1995 and 2006-2007 with rates of 0.15-0.22 and 0.12-0.22 for antenatal- and postpartum-related hospitalizations, respectively. However, the 0.27 rate during delivery remained the same over time. Their analysis further showed that risk of stroke was highest for patients with heart disease and hypertensive disorders.

Overall, about 2 of 3 pregnancies were complicated by stroke in 2006 through 2007. Kuklina and colleagues explained, “Using a large, nationwide hospital discharge dataset, we have demonstrated that the number of pregnancy-related stroke hospitalizations grew by 54%, increasing from ~4000 in 1994 to 1995 to ~6000 hospitalizations in 2006 to 2007.”

Figure. Percentage of patients with hypertensive disorders.

 
“I am surprised at the magnitude of the increase, which is substantial. Our results indicate an urgent need to take a closer look,” Kuklina said in a statement to the press. “Regardless of their pregnancy status, we should use an opportunity when we see young women in clinical practice to estimate their risks of cardiovascular disease and discuss the lifestyle changes to improve cardiovascular health.”

More Information

Healthcare Cost and Utilization Project

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References:

References
Kuklina EV, Tong X, Bansil P, et al. Trends in pregnancy hospitalizations that included a stroke in the United States From 1994 to 2007: reasons for concern?  Stroke. 2011; Jul 28. [Epub].
Brooks M. Pregnancy-related stroke rate rising.  Medscape News Today. July 28, 2011.