Trends in the Incidence and Risk Factors of Pregnancy-Associated Stroke

Abstract

Pregnancy is a female-specific risk factor for stroke. Although pregnancy-associated stroke (PAS) is a rare event, PAS leads to considerable maternal mortality and morbidity. It is estimated that 7.7–15% of all maternal deaths worldwide are caused by stroke and 30–50% of surviving women are left with persistent neurological deficits. During last decade, several studies have reported an increasing incidence of PAS. The objective of this review is to summarize studies on time trends of PAS in relation to trends in the prevalence of stroke risk factors in pregnant women. Seven retrospective national healthcare register-based cohort studies from the US, Canada, UK, Sweden, and Finland were identified. Five studies from the US, Canada, and Finland reported an increasing trend of PAS. Potential biases include more sensitive diagnostics and improved stroke awareness among pregnant women and professionals toward the end of the study period. However, the concurrent increase in the prevalence of several stroke risk factors among pregnant women, particularly advanced age, hypertensive disorders of pregnancy, diabetes, and obesity, indicate that the findings are likely robust and should be considered seriously. To reduce stroke in pregnancy, increased awareness among all medical specialties and pregnant women on the importance of risk-factor management during pregnancy and stroke symptoms is necessary. Important preventive measures include counseling for smoking cessation and substance abuse, treatment of hypertensive disorders of pregnancy, use of aspirin in women at high risk for developing preeclampsia, and antithrombotic medication and pregnancy surveillance for women with high-risk conditions. Epidemiological data from countries with a high risk-factor burden are largely missing. National and international registries and prospective studies are needed to increase knowledge on the mechanisms, risk factors, management, and future implications for the health of women who experience this rare but devastating complication of pregnancy.

Short and long-term complications of hypertensive disorders of pregnancy: lifelong cardiovascular risks we cannot ignore

“…Cardiomyopathy is the most common cause of death beginning at 6 weeks postpartum, and patients with HDP are 13 times more likely to develop peripartum/postpartum cardiomyopathy [21 ▪▪ ]. HDP patients are at increased risk for stroke (OR 3.4) [20 ▪ ], with highest risk for death being antepartum and immediately postpartum [22]. As a result, HDP are the most common cause of postpartum hospital readmission [23].…”

Epidemiological Characteristics and Risk factors of Stroke in Pregnancy and Postpartum Women in Somalia: A Retrospective Study

“…Pregnancy and postpartum-related strokes include ischemic stroke and hemorrhagic stroke, as well as cerebral venous thrombosis (CVT). Further, pregnancy may be linked to other cerebrovascular illnesses such as reversible cerebral vasoconstriction syndrome (PCVS) or posterior reversible encephalopathy syndrome (PRESS) [4,5].…”

Vaginal Delivery Following Thrombolytic Therapy in the Third Trimester: A Case Report

“…Stroke in pregnancy is a leading cause of maternal mortality, as it is estimated that 7.7–15% of all maternal deaths are due to stroke. 1 Risk factors for stroke in women include the prothrombic state of pregnancy and pregnancy-associated complications including preeclampsia and eclampsia. 2 Due to the commonly applied ethical barrier of including pregnant patients in randomized control trials, there are no clear guidelines for the management of pregnancy-associated stroke (PAS).…”