More younger pregnant women face the risk of stroke

Dominika Osmolska Psy.D.'s picture
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Having a stroke as a young woman is just not on most people’s radar. Women of reproductive age have historically been protected from a number of chronic illnesses, such as heart disease. Now a new and alarming statistic, published in the American Heart Association journal Stroke, indicates that pregnant and postpartum women are increasingly at risk for suffering from a stroke.

We are not just talking about older moms. Women in their 20’s and 30’s are experiencing the greatest spike in stroke episodes. Rates of stroke in women during pregnancy or soon after giving birth have jumped 54 percent in a dozen years.

The number of pregnancy-related stroke hospitalizations climbed by more than 2,200 between 1994-95 and 2006-2007. The rate of stroke climbed about 47 percent in women before giving birth and about 83 percent in new moms in the postpartum period, 12 weeks after giving birth. Overall, strokes were detected in about 71 of every 100,000 delivery hospitalizations by the end of the study period.

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Stroke risk rises in pregnancy partially because of a rise in total blood volume, which increases by a full third of the usual volume capacity of the woman before pregnancy. The cardiovascular system has to accommodate this increase – an accommodation that may be compromised by arteries and veins which may already harbor plaque deposits, and which are therefore less elastic. Blood pressure problems and blood clots can result. Pre-eclampsia, a pregnancy-induced disorder characterized by high blood pressure and an impaired metabolism, can also precipitate strokes, both antepartum (before birth) and post-partum.

Dramatic fluctuations in hormones and blood pressure in the weeks after giving birth may also increase risk during that time.

Although it would seem likely that older moms would suffer the greater proportion of strokes, it is precisely the younger moms who appear more susceptible to strokes. Pregnant women and new mothers ages 25 to 34 were hospitalized for stroke more often than women who were younger or older, the study found. Almost all of the increase in strokes during or soon after pregnancy was explained by higher prevalence of high blood pressure and heart disease during pregnancy, said Dr. Elena V. Kuklina, the study’s lead author, stroke expert and epidemiologist at the federal Centers for Disease Control and Prevention.

In a nation in which one in five women is obese when she becomes pregnant, that’s a worrisome trend. Obesity by itself is a risk factor for both heart disease and stroke, so adding pregnancy to the mix can be dangerous for some. The problem is that additional weight is gained during pregnancy, compounding the problem. Sometimes an excessive weight gain during pregnancy can precipitate a stroke in otherwise healthy individuals.

“We are dealing with a different population of pregnant women now,” said Kuklina, who urged better preventive care and monitoring by doctors and pregnant patients.

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