The incidence of acute stroke or transient ischemic attack (TIA) during pregnancy and puerperium has remained unchanged or might be increasing, according to a nationwide observational analysis of pregnancy-related hospitalization from 2007 through 2015, published in the Journal of the American College of Cardiology.

Although acute stroke during pregnancy is not common, it may be devastating for the mother and her family. A previous report pointed to a slow increase in the incidence of acute stroke during pregnancy and puerperium from 1994 to 2007. However, because limited data are available on these trends, the goal of the current study was to explore the trends in the incidence and outcomes of acute stroke during pregnancy and puerperium and the trends in the prevalence of risk factors for acute stroke.

The researchers used data from the Nationwide Inpatient Sample database and identified adult women in the United States who were hospitalized during pregnancy, labor, and the postpartum period due to pregnancy-related condition.

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Among 37,360,772 pregnancy-related hospitalizations between January 2007 and September 2015, 16,694 (0.045%) involved acute stroke or TIA, including 7872 cases (47.2%) of ischemic stroke or TIA, 5169 cases (31.0%) of hemorrhagic stroke, and 3652 cases (21.8%) of unspecified stroke.

The incidence of acute stroke or TIA per 100,000 pregnancy-related hospitalizations has remained largely unchanged: there was an increase from 42.8 in 2007 to 49.5 in 2010, followed by a decrease to 42.2 in 2015 (P =.10).

The researchers identified an increases in the prevalence of several risk factors among patients with acute stroke or TIA, including obesity, smoking, hyperlipidemia, migraine, atrial septal defects, prior stroke, and gestational hypertension. However, the prevalence of other traditional risk factors, such as hypertension and diabetes mellitus did not change.

In-hospital mortality was almost 385-fold higher among pregnant women with acute stroke or TIA versus those without (42.1 per 1000 pregnancy-related hospitalizations vs. 0.11 per 1000 pregnancy-related hospitalizations, respectively; P <.0001). The rates of in-hospital mortality among patients with acute stroke or TIA decreased over time (5.5% in 2007 vs 2.7% in 2015; P <.0001).

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The research noted the study had several limitations, including the observational design, potential of unmeasured confounders and coding errors, and missing data on other outcomes.

“The increases in the trends in ischemic and hemorrhagic stroke noted in our study suggest that we must understand the reasons behind this rise,” concluded the researchers.


Elgendy IY, Gad MM, Mahmoud AN, Keeley EC, Pepine CJ. Acute stroke during pregnancy and puerperium. J Am Coll Cardiol. 2020;75:180-190. doi:10.1016/j.jacc.2019.10.056