Author + information
- Received September 19, 2019
- Revision received October 17, 2019
- Accepted October 28, 2019
- Published online January 13, 2020.
- Islam Y. Elgendy, MDa,∗∗ (, )@islamelgendy83,
- Mohamed M. Gad, MDb,∗,
- Ahmed N. Mahmoud, MDc,
- Ellen C. Keeley, MD, MSd and
- Carl J. Pepine, MDd
- aDivision of Cardiology Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- bHeart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- cDivision of Cardiology, University of Washington, Seattle, Washington
- dDivision of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
- ↵∗Address for correspondence:
Dr. Islam Y. Elgendy, 55 Fruit St., GRB-800, Boston, Massachusetts 02114.
Background Acute stroke during pregnancy or within 6 weeks of childbirth is devastating for the mother and her family, yet data regarding incidence and contemporary trends are very limited.
Objectives This study sought to investigate the incidence and outcomes of acute stroke and transient ischemic attack during pregnancy or within 6 weeks of childbirth in a large database.
Methods The National Inpatient Sample was queried to identify women age ≥18 years in the United States with pregnancy-related hospitalizations from January 1, 2007, to September 30, 2015. Temporal trends in acute stroke (ischemic and hemorrhagic)/transient ischemic attack incidence and in-hospital mortality were extracted.
Results Among 37,360,772 pregnancy-related hospitalizations, 16,694 (0.045%) women had an acute stroke. The rates of acute stroke did not change (42.8 per 100,000 hospitalizations in 2007 vs. 42.2 per 100,000 hospitalizations in 2015; ptrends = 0.10). Among those with acute stroke, there were increases in prevalence of obesity, smoking, hyperlipidemia, migraine, and gestational hypertension. Importantly, in-hospital mortality rates were almost 385-fold higher among those who had a stroke (42.1 per 1,000 pregnancy-related hospitalizations vs. 0.11 per 1,000 pregnancy-related hospitalizations; p < 0.0001). The rates of in-hospital mortality among pregnant women with acute stroke decreased (5.5% in 2007 vs. 2.7% in 2015; ptrends < 0.001).
Conclusions In this contemporary analysis of pregnancy-related hospitalizations, acute stroke occurred in 1 of every 2,222 hospitalizations, and these rates did not decrease over approximately 9 years. The prevalence of most stroke risk factors has increased. Acute stroke during pregnancy and puerperium was associated with high maternal mortality, although it appears to be trending downward. Future studies to better identify mechanisms and approaches to prevention and management of acute stroke during pregnancy and puerperium are warranted.
↵∗ Drs Elgendy and Gad contributed equally to this work and are co-first authors.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 19, 2019.
- Revision received October 17, 2019.
- Accepted October 28, 2019.
- 2020 American College of Cardiology Foundation
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