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Clinical question
How common is stroke related to pregnancy and what are the risk factors?
Bottom line
Hospitalization with a diagnosis of stroke in pregnancy or puerperium occurs
in 34 per 100,000 deliveries in the United States. It occurs in more that 50
per 100,000 in African American women and women older than 35 years. The
most common comorbid conditions associated with increased risk are migraine
headache and hypertension (including gestational hypertension).
Reference
James AH, Bushnell CD, Jamison MG, Myers ER. Incidence and risk factors for
stroke in pregnancy and the puerperium. Obstet Gynecol 2005;106:509-16.
Study design: Descriptive
Setting: Population-based
Synopsis
Stroke is a potentially devastating event that, although rare in pregnancy,
is more common in pregnant than nonpregnant women of childbearing age. This
study documented the rate of pregnancy-related stroke, and associated
demographic and comorbid conditions, based on diagnoses recorded in hospital
discharges from 2000-2001 included in the Nationwide Inpatient Sample of the
Healthcare Cost and Utilization Project of the Agency for Healthcare
Research and Quality. There were 2850 stokes identified among 9,135,755
pregnancy-related discharges, including 8,322,799 deliveries for an overall
rate of 34 strokes per 100,000 deliveries. Of the strokes, 11% were
identified on antenatal admissions, 41% during admissions (including
delivery), and 48% on postpartum admissions. Rates of stroke increased with
increasing maternal age with rates of 58 per 100,000 deliveries at ages 35
to 39 years and 90 per 100,000 for women 40 years or older. African American
women had a higher rate overall of 52 per 100,000. Several comorbid
conditions had associations with statistically significant odds ratios (ORs):
migraine headache, thrombophilia, systemic lupus, heart disease, sickle cell
disease, hypertension, and thrombocytopenia (ORs = 17, 16, 13, 9, and 6,
respectively). Complications of pregnancy with significant associations were
postpartum infection, transfusion, gestational hypertension and preeclampsa,
and postpartum hemorrhage (ORs = 25, 10, 4, and 2, respectively). A total of
4% of patients with stroke died, and 22% of survivors were discharged to
another facility rather than home. |