Stroke Risk in Pregnant Women

It's long been known that high blood pressure during pregnancy is a leading cause of maternal and fetal mortality worldwide. And now recent research has found that pregnant women face a risk of stroke that is 2.4 times higher than the risk in nonpregnant women.

Several of my colleagues in the Neurology Department reported this troubling statistic in a recent review article, in the journal Women's Health, on pregnancy-induced high-blood-pressure syndromes. They wrote: "Prompt diagnosis and identification of patients at risk allows for early therapeutic interventions and improved clinical outcomes."

Pregnancy-induced high-blood-pressure syndromes include pre-eclampsia, eclampsia and a rare but serious illness called HELLP (hemolysis, elevated liver enzymes and low platelet count).

Pre-eclampsia is a multisystem disorder characterized by high blood pressure (top or bottom numbers equal to or greater than 140/90, when measured on two occasions six hours apart) and proteinuria (excess protein in urine--more than 300 mg. in 24 hours).

Left untreated, pre-eclampsia can cause serious complications, possibly fatal, in the mother and baby. In severe pre-eclampsia, patients may develop oliguria (reduced urine output), pulmonary edema (fluid in the lungs), liver dysfunction, thrombocytopenia (low platelet count) and changes in mental status and other cerebral symptoms. Patients may have headaches, stupor, visual blurring, blindness (often temporary) or seizures.

Pre-eclampsia can progress to eclampsia or HELLP. Pre-eclampsia develops into eclampsia when a patient experiences convulsive seizures or goes into a coma. HELLP can cause bleeding, liver problems and high-blood-pressure problems, harming both mother and baby.

Pre-eclampsia/eclampsia-related events are a major cause of maternal disability and maternal and fetal death in the U.S., and without prompt and aggressive treatment these patients may rapidly decline. For pregnant women who have pre-eclampsia risk factors, starting aspirin at 12 to 14 weeks may decrease the risk of pre-eclampsia and death of the baby.

Once a patient is diagnosed with pre-eclampsia/eclampsia, physicians attempt to control blood pressure and seizures and manage brain swelling. But the only sure treatment is to promptly deliver the baby.

Women who have pre-eclampsia are at higher risk for stroke and cardiovascular disease in the future. A major focus of research will be to identify patients who are at risk of pregnancy-induced high-blood-pressure syndrome.

Tagged as: stroke, pregnancy, high blood pressure, maternal and women

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Dr. Anita Varkey is medical director of the general medicine clinic at Loyola Outpatient Center at Loyola University Health System. Dr. Varkey is an internist, researcher and professor who specializes in primary care, preventive medicine and women's health. "TCWell" focuses on health and wellness issues.