In the Journals

Stroke occurs in 1 of every 2,222 pregnancy-related hospitalizations

Islam Y. Elgendy

The rate of acute strokes in pregnancy-related hospitalizations did not decrease from 2007 to 2015, according to a study published in the Journal of the American College of Cardiology.

Acute stroke during pregnancy or shortly thereafter was linked to high maternal mortality, although this may be trending downward, according to the study.

“In the recent years, there has been an increase in the incidence of maternal mortality rates in the United States, and cardiovascular disease is a leading cause,” Islam Y. Elgendy, MD, research fellow in medicine at Massachusetts General Hospital, told Healio. “This study evaluated the national trends of acute stroke among pregnant and postpartum women. We found that the rates of acute stroke during pregnancy have not changed or might be rising. We also found that the prevalence of most risk factors for acute stroke have been also increasing. Although, acute stroke is associated with high maternal mortality, reassuringly the rates of maternal mortality are decreasing.”

National Inpatient Sample data

Researchers analyzed data from 37,360,772 pregnancy-related hospitalizations (median age, 28 years) between January 2007 and September 2015 from the National Inpatient Sample. Information on baseline characteristics was collected including demographics and medical comorbidities.

The primary outcome was the incidence trend for acute stroke during pregnancy and the puerperium. Secondary outcomes were defined as the rates and trends of in-hospital mortality in women with stroke and the trends of risk factors for acute stroke during pregnancy.

Of the women in the study, 0.045% had an acute stroke, of which 47.2% was ischemic stroke/transient ischemic attack, 31% was hemorrhagic stroke and 21.8% was unspecified. The rate of acute stroke/TIA was largely unchanged from 42.8 per 100,000 hospitalizations in 2007 to 42.2 per 100,000 hospitalizations in 2015 (P for trend = .1), or approximately 1 for every 2,222 hospitalizations.

There was an increased prevalence in risk factors in women with acute stroke including smoking, obesity, atrial septal defects, hyperlipidemia, migraine, gestational hypertension and prior stroke. The prevalence of other traditional risk factors including diabetes and hypertension was unchanged.

Pregnant women with acute stroke/TIA had a 385-fold increased risk for in-hospital mortality compared with those without a stroke event (42.1 per 1,000 pregnancy-related hospitalizations vs. 0.11 per 1,000 pregnancy-related hospitalizations; P < .0001). In-hospital mortality rates in women with acute stroke/TIA decreased from 5.5% in 2007 to 2.7% in 2015 (P for trend < .0001).

“The findings from this study highlight several important aspects,” Elgendy said in an interview. “The incidence of acute stroke and the risk factors are increasing. Importantly, most of these risk factors are preventable, thus interventions targeting preventive measures are needed in young women.”

Stroke risk awareness

Ralph L. Sacco

In a related editorial, Ralph L. Sacco, MD, MS, chairman of the department of neurology and the Olemberg Family Chair of Neurological Disorders at the University of Miami Miller School of Medicine, and Nicole B. Sur, MD, assistant professor of clinical neurology at the University of Miami Miller School of Medicine, wrote: “Although stroke in pregnancy is rare, health care systems and providers involved in the care of pregnant and peripartum women should be knowledgeable about the risk of stroke and associated mortality and evidence-based treatment recommendations. Screening for pertinent risk factors and vulnerable populations can help with the early implementation of effective preventive and treatment measures.” – by Darlene Dobkowski

For more information:

Islam Y. Elgendy, MD, can be reached at 55 Fruit St., GRB-800, Boston, MA 02114; email: iyelgendy@gmail.com; Twitter: @islamelgendy83.

Disclosures: The authors of the study and Sur report no relevant financial disclosures. Sacco reports he received research funding from the National Center for Advancing Translational Sciences, the National Institute of Neurological Disorders and Stroke and Florida Department of Health. Please see the study for all other authors’ relevant financial disclosures.

Islam Y. Elgendy

The rate of acute strokes in pregnancy-related hospitalizations did not decrease from 2007 to 2015, according to a study published in the Journal of the American College of Cardiology.

Acute stroke during pregnancy or shortly thereafter was linked to high maternal mortality, although this may be trending downward, according to the study.

“In the recent years, there has been an increase in the incidence of maternal mortality rates in the United States, and cardiovascular disease is a leading cause,” Islam Y. Elgendy, MD, research fellow in medicine at Massachusetts General Hospital, told Healio. “This study evaluated the national trends of acute stroke among pregnant and postpartum women. We found that the rates of acute stroke during pregnancy have not changed or might be rising. We also found that the prevalence of most risk factors for acute stroke have been also increasing. Although, acute stroke is associated with high maternal mortality, reassuringly the rates of maternal mortality are decreasing.”

National Inpatient Sample data

Researchers analyzed data from 37,360,772 pregnancy-related hospitalizations (median age, 28 years) between January 2007 and September 2015 from the National Inpatient Sample. Information on baseline characteristics was collected including demographics and medical comorbidities.

The primary outcome was the incidence trend for acute stroke during pregnancy and the puerperium. Secondary outcomes were defined as the rates and trends of in-hospital mortality in women with stroke and the trends of risk factors for acute stroke during pregnancy.

Of the women in the study, 0.045% had an acute stroke, of which 47.2% was ischemic stroke/transient ischemic attack, 31% was hemorrhagic stroke and 21.8% was unspecified. The rate of acute stroke/TIA was largely unchanged from 42.8 per 100,000 hospitalizations in 2007 to 42.2 per 100,000 hospitalizations in 2015 (P for trend = .1), or approximately 1 for every 2,222 hospitalizations.

There was an increased prevalence in risk factors in women with acute stroke including smoking, obesity, atrial septal defects, hyperlipidemia, migraine, gestational hypertension and prior stroke. The prevalence of other traditional risk factors including diabetes and hypertension was unchanged.

Pregnant women with acute stroke/TIA had a 385-fold increased risk for in-hospital mortality compared with those without a stroke event (42.1 per 1,000 pregnancy-related hospitalizations vs. 0.11 per 1,000 pregnancy-related hospitalizations; P < .0001). In-hospital mortality rates in women with acute stroke/TIA decreased from 5.5% in 2007 to 2.7% in 2015 (P for trend < .0001).

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“The findings from this study highlight several important aspects,” Elgendy said in an interview. “The incidence of acute stroke and the risk factors are increasing. Importantly, most of these risk factors are preventable, thus interventions targeting preventive measures are needed in young women.”

Stroke risk awareness

Ralph L. Sacco

In a related editorial, Ralph L. Sacco, MD, MS, chairman of the department of neurology and the Olemberg Family Chair of Neurological Disorders at the University of Miami Miller School of Medicine, and Nicole B. Sur, MD, assistant professor of clinical neurology at the University of Miami Miller School of Medicine, wrote: “Although stroke in pregnancy is rare, health care systems and providers involved in the care of pregnant and peripartum women should be knowledgeable about the risk of stroke and associated mortality and evidence-based treatment recommendations. Screening for pertinent risk factors and vulnerable populations can help with the early implementation of effective preventive and treatment measures.” – by Darlene Dobkowski

For more information:

Islam Y. Elgendy, MD, can be reached at 55 Fruit St., GRB-800, Boston, MA 02114; email: iyelgendy@gmail.com; Twitter: @islamelgendy83.

Disclosures: The authors of the study and Sur report no relevant financial disclosures. Sacco reports he received research funding from the National Center for Advancing Translational Sciences, the National Institute of Neurological Disorders and Stroke and Florida Department of Health. Please see the study for all other authors’ relevant financial disclosures.