Rising Incidence of Stroke in Pregnancy

Sacco, Ralph L.; Sur, Nicole B.

doi:10.1016/j.jacc.2019.11.029

Cited by 6 publications

(8 citation statements)

References 11 publications

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“…According to our findings and previous literature, important measures of primary prevention include counseling for smoking cessation, screening and treatment of hypertensive disorders of pregnancy, use of aspirin as a secondary prevention in women at high risk for developing preeclampsia, and adequate antithrombotic or anticoagulant medication and pregnancy surveillance for women with predisposing high-risk conditions (such thrombophilias, heart diseases, previous stroke, or other diseases of cerebral vasculature). 9,21,37,[39][40][41] Follow-up after delivery should be extended to early postpartum, considering the associated increased risk and age-related risk increase noted among older expectant mothers.…”

Section: Discussionmentioning

confidence: 99%

“…8 Recent studies from the United States 2,3 and Canada 5 suggest an increase in PAS incidence; the main contributors are an increase in hypertensive disorders of pregnancy, advanced maternal age, and maternal comorbid conditions such as cardiac disease and associated risk factors. 2-4,9 Only a few studies are population based, 5-7,10-14 and none of these studies have validated the register data from patient records. Validation of register data is essential to avoid biased incidence estimation by verifying the temporal connection of stroke to the pregnant or postpartum period and for more accurate reporting of stroke types.…”

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confidence: 99%

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Stroke in Pregnancy and Puerperium

et al. 2021

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Objective:To investigate whether previously reported increasing incidence of pregnancy-associated stroke (PAS) is observed in chart-validated register data in Finland. In an exploratory analysis, we studied risk factors for PAS.Methods:We performed a retrospective population-based cohort study and nested case-control study in Finland 1987-2016. The Medical Birth Register (MBR) was linked with the Hospital Discharge Register to identify women with incident stroke (ischemic stroke, cerebral venous thrombosis, intracerebral or subarachnoid hemorrhage) during pregnancy or puerperium. Cases were verified from patient records. Incidence of PAS over the study period, in 5-year age groups and pregnancy/postpartum period were calculated per number of deliveries. Three matched controls were selected for each case from MBR to compare risk factors.Results:After chart review, 29.6% (257/868) of cases were PAS. The incidence of PAS was 14.5 (95%CI: 12.8-16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987-1991 to 2012-2016 (p<0.0001). Incidence increased by age from 9.8 to 29.9 per 100,000 deliveries from ages 20-24 to ages >40 (p<0.0001). During early postpartum period, incidence was 5-fold greater compared to the first trimester. Maternal mortality was 6.6%. In the multivariable adjusted model, smoking beyond 12 gestational weeks (odds ratio [OR] 1.8, 95%CI: 1.2-2.7), migraine (OR 16.3, 95%CI: 5.3-49.8), and hypertensive disorders of pregnancy (OR 4.0, 95%CI: 2.5-6.3) were the most important risk factors for PAS.Conclusion:PAS incidence is increasing stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium.Classification of Evidence:This study provides Class III evidence that smoking beyond 12 gestational weeks, migraine and hypertensive disorders of pregnancy are associated with an increased risk of PAS.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Stroke in Pregnancy and Puerperium

et al. 2021

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“…It is a life‐threatening emergency for the mother and the child. The incidence is increasing in several countries, 2–5 possibly as the result of increasing maternal age and comorbidities 2,3,6,7 …”

Section: Introductionmentioning

confidence: 99%

“…The incidence is increasing in several countries, [2][3][4][5] possibly as the result of increasing maternal age and comorbidities. 2,3,6,7 Pregnancy-associated stroke is a significant contributor to maternal mortality and morbidity, 8,9 but many women recover well enough to opt for further pregnancies. 10,11 Data on the course and risks associated with the subsequent pregnancies are needed for preconception counselling.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy‐associated stroke and the recurrence of stroke and other complications in subsequent pregnancies: Population‐based retrospective cohort study

Karjalainen

Tikkanen

Äyräs

et al. 2023

BJOG

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ObjectiveTo examine the outcomes of the subsequent pregnancies from women with a previous pregnancy‐associated stroke (PAS) in comparison to matched controls.DesignPopulation‐based retrospective cohort study.Setting and populationAll women with a PAS in Finland 1987–2016 (n = 235) and controls (n = 694).MethodsWe identified all subsequent deliveries and induced and spontaneous abortions for women with a previous PAS and their matched controls from the Medical Birth Register and the Hospital Discharge Register until 2016. The number, course and outcomes of the subsequent pregnancies were compared. Patient records were studied for PAS recurrence.Main outcome measuresPAS recurrence and pregnancy complications.ResultsWomen with a previous PAS had fewer subsequent deliveries: 73 (31.1%) women had 122 deliveries in all, whereas 303 (47.3%) of the controls had 442 deliveries (age‐adjusted odds ratio [OR] 0.54, 95% CI 0.38–0.76). Hypertensive disorders of pregnancy (HDP) (17.2% versus 5.7%, age‐adjusted OR 4.0, 95% CI 1.7–9.3), especially chronic hypertension (age‐adjusted OR 5.9, 95% CI 1.5–24.7), and any diabetes during pregnancy (24.6% versus 14.5%, age‐adjusted OR 2.0, 95% CI 1.1–3.8) were more common in cases. Regarding HDP, the difference between groups was explained by underlying factors such as index pregnancy HDP (multivariable OR 2.4, 95% CI 0.8–6.7). PAS recurred in four cases (5.5%).ConclusionsSubsequent pregnancies of women with a history of PAS are more often complicated with hypertensive disorders of pregnancy and any diabetes during pregnancy. PAS recurrence risk is considerable.

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“…3 Pregnancy is increasingly complicated by stroke. 4 The etiology of a stroke correlates with its neuroanatomical location in the brain, clinical presentation, and appropriate treatment. 5 Appropriate treatment of stroke is a matter of extreme urgency because neurons die rapidly, within minutes of losing their blood supply.…”

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Where in the Brain do Strokes Occur? A Pilot Study and Call for Data

et al. 2021

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Background: Every year, more than 795,000 people in the United States have a stroke, and each year about 140,000 Americans die from strokes. Although there is abundant information on the epidemiology, risk factors, pathophysiology, and many clinical features of strokes, there is a lack of specific numerical quantitation on the neuroanatomical distribution of strokes.Methods: This retrospective study utilized de-identified reports of radiologic imaging to determine the neurovascular anatomical location of acute ischemic cerebral infarcts in a 637-bed regional hospital in a rural area during the one-year interval from October 1, 2018 through September 30, 2019.Results: During the one-year study period, there were 418 acute ischemic strokes, and 54.6% (228/418) were in the territory of a single large vessel. Of the single large vessel strokes, 62.3% (142/228) were in a middle cerebral artery (MCA) territory, 12.1% (29/228) in a posterior cerebral artery (PCA) territory, 8.8% (20/228) in a basilar artery distribution, 7.5% (17/228) in a posterior inferior cerebellar artery (PICA) distribution, 6.6% (15/228) in an anterior cerebral artery (ACA) distribution, 1.8% (4/228) in a superior cerebellar artery (SCA) distribution, and 0.4% (1/228) in an anterior inferior cerebellar artery (AICA) territory. Internal capsule lacunar strokes accounted for 17.7% (74/418) of the total, brainstem lacunar strokes for 8.1% (34/418) and thalamic lacunar strokes for 5% (21/418) of the infarctions. Watershed infarctions accounted for 2.9% (12/418) of the strokes, 9 in the MCA/PCA watershed area and 3 in the MCA/ACA watershed area.Conclusions: This pilot study illustrates a methodology for collecting data to substitute specific numerical quantitation for vague generalities about the neuroanatomical distribution of strokes. Such quantification can enable evidence-based data-driven improvements in the care of stroke patients.

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Rising Incidence of Stroke in Pregnancy

Cited by 6 publications

References 11 publications

Stroke in Pregnancy and Puerperium

Stroke in Pregnancy and Puerperium

Pregnancy‐associated stroke and the recurrence of stroke and other complications in subsequent pregnancies: Population‐based retrospective cohort study

Where in the Brain do Strokes Occur? A Pilot Study and Call for Data

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