Pharmacy Residency (PGY1)

Parkland expert urges pregnant women to reduce risk factors for strokes

Obesity, high blood pressure key concerns

Pregnancy and childbirth are happy experiences for most women, but for a few, they bring an unexpected risk for stroke.

While the incidence of pregnancy-related strokes is rare and the numbers relatively small when compared to the general population, there has been an increase in reports of strokes in pregnant women and those who have just given birth.

“Some important risks for increased stroke in a younger population, and in particular pregnant women, include higher rates of obesity, diabetes and high blood pressure. All of these are risk factors for stroke and heart attacks in general, and they are all risks that can be treated or controlled,” said Alejandro Magadan, MD, Medical Director of the Parkland Stroke Program and Assistant Professor of Neurology and Neurotherapeutics at The University of Texas Southwestern Medical Center.

In 2015, the American Heart Association and the United States Preventive Services Task Force urged aggressive treatment of high blood pressure in pregnancy, moderate exercise during pregnancy and a healthy diet.

Even though these kinds of strokes are rare, a recent study in the journal Obstetrics & Gynecology reported a 61.5 percent increase in pregnancy-related strokes from the mid-1990s to 2011. The researchers also found a 103 percent increase in stroke rate for women ages 15 to 44 who had high blood pressure during pregnancy or disorders related to hypertension including pre-eclampsia and eclampsia – conditions in which a pregnant woman develops high blood pressure and protein in the urine, a sign of possible kidney problems. In its most severe form eclampsia can result in loss of consciousness and seizures.

According to the study, which analyzed data from nearly 82 million hospitalizations of pregnant women, there were 31,000 hospitalizations for stroke over a 17-year period.

“It is very important that if you have risk factors for stroke such as high blood pressure, obesity or lack of physical exercise that you talk to your doctor about those risks and implement plans to manage these risks. They are relatively simple problems to manage early on before having a stroke which is potentially a devastating and life-altering event,” Dr. Magadan said. “Pregnant women should especially be urged to consult with and follow their doctor’s recommendations when it comes to medications, such as those to control blood pressure and, perhaps more importantly, implement healthy diet and exercise regimens.”

One of the more common pregnancy-related strokes is venous sinus thrombosis, or clotting of the blood in veins of the brain. Typically, hormonal changes toward the end of pregnancy or within the first six weeks of the postpartum period are thought to lead to an increased rate of clotting in the veins. But all of these disorders are relatively rare.

About 10 percent of pregnancy-related strokes occur before delivery, while about 40 percent occur during labor or delivery; the other 50 percent occur within six weeks of the baby’s birth. The most common symptoms of stroke are facial drooping, arm weakness and speech difficulty due to a blocked vessel. Symptoms also can include a sudden, severe and persistent headache, light sensitivity and confusion. It is important to seek urgent medical attention if you experience any of these symptoms.

Learn more about how Parkland cares for women and inftants and stroke patients.