Susan Bewley (Guy's and St Thomas' Hospital, London)
Charles Wolfe (Guy's and St Thomas' Hospital, London), Tony Rudd (Guy's and St Thomas' Hospital, London), Beverley Hunt (Guy's and St Thomas' Hospital, London), Marian Knight (NPEU), Cathy Scott (NPEU (Former member))
Severe maternal morbidity and mortality
Wellbeing of Women
Stroke is an important cause of morbidity and mortality, the incidence of which is likely to increase due to an ageing population.
However, estimates of the incidence of stroke associated with pregnancy vary widely.
This study was designed to estimate the incidence of antenatal stroke in the UK and to identify risk factors associated with stroke during pregnancy.
Information on the clinical features, current management, survival and prognosis of antenatal strokes was also obtained in order to develop guidance and improve the care of women having an antenatal stroke.
Thirty cases of antenatal stroke were reported giving an estimated incidence of 1.5 cases per 100,000 maternities (95% CI 1.0-2.1). The incidences of non-haemorrhagic and haemorrhagic stroke were 0.9 (95% CI 0.5-1.3) and 0.6 (95% CI 0.3-1.0) per 100 000 maternities.
Factors associated with increased risk of antenatal stroke were history of migraine (OR 8.5, 95% CI 1.5-62.1), gestational diabetes (OR 26.8, 95% CI 3.2-?), and preeclampsia or eclampsia (OR 7.7, 95% CI 1.3-55.7).
There was wide variation in the use of pharmacological and surgical management, and organized stroke unit care.
There were six stroke-related maternal deaths giving a case fatality rate of 20% of all strokes, and 50% of haemorrhagic strokes, and a mortality rate of 0.3 (95% CI 0.1?0.6) per 100 000 maternities.
This study suggests that the risk of a stroke during pregnancy is low, however the poor outcomes in terms of morbidity and mortality and variations in care highlight the importance of such women receiving specialist stroke care.
Clinicians should be aware of the increased risk in women with a history of migraine, gestational diabetes and pre-eclampsia or eclampsia.