Incidence of pregnancy related stroke is
greater in younger women than in older women, suggests a recent study from
Columbia University Medical Center and New York-Presbyterian.
What Did the Study Aim to Establish
The research team from Columbia University
Medical Center and New York-Presbyterian wished to compare the incidence of
stroke in women in the pregnant state versus incidence in the not pregnant
state, belonging to the same age group
Earlier studies have indicated that risk of
pregnancy-associated stroke is higher in older women than in younger women. The
reason for this finding might be due to the fact that women nowadays delay
childbearing until they are older, when the overall incidence of stroke is more
said one of the study authors.
"However, very few studies have compared the
incidence of stroke in pregnant and non-pregnant women who are the same age",
said Joshua Z. Willey, MD, assistant professor of neurology at CUMC, assistant
attending neurologist on the stroke service at New York-Presbyterian/Columbia,
and a senior author on the paper.
Details of the Study
In this study, the researchers collected
information regarding every woman hospitalized due to stroke in New York State between the years 2003 and 2012. Among the 19,146 women, aged between 12 to
55 years, 797 (4.2 percent) were either pregnant or had just given birth.
The researchers reported the following results
- The overall incidence of stroke
during or soon after pregnancy (postpartum) rose with age (46.9 per 100,000
in women age 45 to 55 vs 14 per 100,000 in women age 12 to
- However, the risk of stroke in pregnant and postpartum women in the youngest group (age 12 to 24) was more than twice that of non-pregnant women in the
same age group (14 per 100,000 in pregnant women vs 6.4 in non-pregnant women).
women aged 25 to 34, pregnancy increased the risk of stroke by
1.6 times. The risk of stroke was same in pregnant and non-pregnant women
after 35 years of age. ).
"We have been warning older women that
pregnancy may increase their risk of stroke, but this study shows that their
stroke risk appears similar to women of the same age who are not pregnant,"
said Eliza C. Miller, MD, a vascular neurology fellow in the Department of Neurology at CUMC and New York-Presbyterian
and lead author of the study. "But in
women under 35, pregnancy significantly increased the risk of stroke. In fact,
1 in 5 strokes in women from that age group were related to pregnancy. We need
more research to better understand the causes of pregnancy-associated stroke,
so that we can identify young women at the highest risk and prevent these
Possible Causes of Pregnancy Associated Stroke
refers to brain damage and dysfunction that occurs following a vascular
cause namely arterial occlusion and hemorrhage
. It is one of the most common reasons for long term morbidity.
Many studies have shown that pregnancy
increases the risk of stroke, but data available varies greatly. Interestingly,
some studies have found that the incidence of stroke increased immediately
after delivery (postpartum period), than actually during the pregnancy.
Risk Factors for Stroke and Cerebral Venous Thrombosis in Pregnancy
The risk factors of pregnancy associated
stroke are manifold, with some of them preexisting, and others occurring during
pregnancy or delivery. They include
Complications related to pregnancy, and delivery
- Preeclampsia and eclampsia
- Sickle cell
- Tobacco or other substance
may also increase the risk of stroke, such as
- Excessive morning
sickness (hyperemesis gravidarum)
- Postpartum bleeding
electrolyte and acid-base disorders
- Transfusion and Infection
Although data varies widely, many experts suggest that in pregnant women
with identifiable risk factors for stroke such as hypertension,
diabetes, age more than 35 years, obesity, hyperlipidemia, previous eclampsia,
valvular heart disease and renal disease,
lines of management may be considered, after weighing the risks against the
benefits specific to each patient.
- Low dose aspirin
heparin (UFH) or low molecular weight heparin (LMWH)
Although incidence of stroke is generally less
in younger women, its incidence associated with pregnancy is on the rise,
attributable to various factors. It is therefore
important to identify risk factors during pregnancy if any, and initiate prompt
management to prevent the occurrence of this devastating condition.
- Pregnancy and Stroke Risk in Women - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC3137888/)