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06 September 2011

Pregnancy-linked strokes increasing

The rate of pregnancy-related strokes has increased significantly in the past dozen years, according to a report published online in Stroke.

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The rate of pregnancy-related strokes has increased significantly in the past dozen years, according to a report published online in Stroke.

"The quickly growing rate of stroke before and after delivery indicates that clinicians who take care of pregnant women with pre-existing heart disease and hypertensive disorders should be particularly vigilant for signs and symptoms potentially indicative of stroke during the antenatal and postpartum periods," Dr Elena V. Kuklina from the Centers for Disease Control and Prevention in Atlanta said.

"Physicians should also consider using a low threshold for initiating a diagnostic investigation to exclude this complication," she said.

For their study, Dr Kuklina and colleagues tapped into data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project.

Between 1994 to 2007, the rate of any stroke per 1,000 deliveries increased by 47% during antenatal hospitalisations (from 0.15 to 0.22) and by 83% for postpartum hospitalisations (from 0.12 to 0.22) for postpartum hospitalisations.

The rate did not change for delivery hospitalisations (0.27 per 1000 deliveries).

The prevalence of hypertension increased during the study period, but only the increase during postpartum hospitalizations was statistically significant. The prevalence of heart disease did not change significantly, and the data for postpartum haemorrhage was incomplete.

Stroke high in women with heart disease

The likelihood of stroke was significantly higher among women with heart disease and among women with hypertensive disorders, the researchers report. In fact, they note, "adjustment for heart disease and hypertensive disorders in the postpartum period explained almost all increases in the estimated risk of stroke in 2006 to 2007 compared with 1994 to 1995."

"The data on preventative treatment of stroke in pregnancy is very limited," Dr Kuklina said, adding that most come from small, observational studies. "The best way to prevent stroke during pregnancy remains the same," Dr Kuklina explained.

"Women of reproductive age should try to reach and maintain optimal health status before pregnancy, and physicians who see women of reproductive age on a regular basis should use these visits as an opportunity for nutritional and lifestyle counselling."

Dr Kuklina added, "Although anticoagulant therapy is a recognised treatment for pregnant women with high-risk thromboembolic conditions, such as hypercoagulable state or a prosthetic valve replacement, the 2008 American College of Cardiology/2011 American Heart Association guidelines acknowledge that currently, there is not sufficient evidence to make definitive recommendations about optimal antithrombotic therapy in these women."

(Reuters Health, Will Boggs MD, September 2011) 

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