Infections, hypertension, bleeding disorders, and clot-forming conditions increase stroke risk during and after childbirth

May 25, 2017

Women with preeclampsia, a common complication of pregnancy, face a heightened risk of stroke during pregnancy and postpartum if they have urinary tract infections, chronic high blood pressure, or clotting or bleeding disorders, according to a study by Columbia University Medical Center (CUMC) and NewYork-Presbyterian researchers.

The study, among the most comprehensive analyses of its kind, was published online today in the journal Stroke.

“We have suspected that certain conditions raise the risk of stroke in women with preeclampsia, but few studies have taken a rigorous look at this issue,” said lead author Eliza C. Miller, MD, a postdoctoral vascular neurology fellow in the department of neurology at NewYork-Presbyterian/Columbia University Medical Center. “Since strokes can be so devastating, it is critical to know whether these are just random events or due to modifiable risk factors.”

Preeclampsia—newly elevated blood pressure during pregnancy—develops in about 3 to 8 percent of all pregnant women, according to the researchers. The cause of preeclampsia is not well understood. While preeclampsia can be mild and symptomless, it can quickly become severe. Left untreated, severe preeclampsia can have serious consequences for both mother and fetus. One of the most dangerous complications is pregnancy-associated stroke, which occurs up to 6 times as often in women with preeclampsia compared with pregnant women overall.

In the study, Dr. Miller and her colleagues analyzed the health records of 197 women who had a preeclampsia-related stroke and 591 women with preeclampsia who did not have a stroke, according to the New York State Department of Health inpatient database. The incidence of stroke in women with preeclampsia was over 200 per 100,000 deliveries, and more than one in 10 women in the study who had a preeclampsia-related stroke died in the hospital.

“Women with preeclampsia who had chronic hypertension, bleeding or clotting disorders, or infections—particularly urinary tract infections—appeared to be at significantly increased risk of stroke,” said Dr. Miller.

“The role of infection was perhaps the biggest question mark going into the study,” said Dr. Miller. “Infections cause inflammation, which is known to  play an important role in triggering stroke, especially in young people. Preeclampsia itself is an inflammatory disorder. Infections may be what pushed some of these women over the edge.”

“The take-home message for pregnant women with preeclampsia and their doctors is to pay close attention to these risk factors, as well as to warning signs for stroke,” said Dr. Miller. “It’s important to note that the risk of stroke in women with preeclampsia doesn’t end with delivery, as is commonly thought. About two-thirds of preeclampsia-related strokes occur after birth, when the mother has gone home. With all the stress of having a new baby, mothers sometimes ignore symptoms like headaches that could be a sign of a serious problem. They think, ‘I’m tired, I just had a baby—of course, I have a headache.’ But this is not something to take lightly. Call your doctor if you have any signs and symptoms of stroke.”

The study is titled, “Risk Factors for Pregnancy-Associated Stroke in Women with Preeclampsia.” The other contributors are: Hajere J. Gatollari (CUMC), Gloria Too (CUMC and NewYork-Presbyterian), Amelia K. Boehme (CUMC), Lisa Leffert (Massachusetts General Hospital, Boston, MA), Randolph S. Marshall (NewYork-Presbyterian/CUMC), Mitchell S.V. Elkind (NewYork-Presbyterian/CUMC), and Joshua Z. Willey (NewYork-Presbyterian/CUMC).

The study was supported by funds from the National Institute of Neurological Disorders and Stroke.

The researchers declare no financial or other conflicts of interest.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. The campus that Columbia University Medical Center shares with its hospital partner, NewYork-Presbyterian, is now called the Columbia University Irving Medical Center. For more information, visit cumc.columbia.edu or columbiadoctors.org.

NewYork-Presbyterian

NewYork-Presbyterian is one of the nation’s most comprehensive, integrated academic healthcare delivery systems, whose organizations are dedicated to providing the highest quality, most compassionate care and service to patients in the New York metropolitan area, nationally, and throughout the globe. In collaboration with two renowned medical schools, Weill Cornell Medicine and Columbia University Medical Center, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and innovative, patient-centered clinical care.

NewYork-Presbyterian has four major divisions:

  • NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the Honor Roll of “America’s Best Hospitals.”
  • NewYork-Presbyterian Regional Hospital Network comprises hospitals and other facilities in the New York metropolitan region.
  • NewYork-Presbyterian Physician Services, which connects medical experts with patients in their communities.
  • NewYork-Presbyterian Community and Population Health, encompassing ambulatory care network sites and community healthcare initiatives, including NewYork Quality Care, the Accountable Care Organization jointly established by NewYork-Presbyterian Hospital, Weill Cornell Medicine and Columbia.

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