A recent report says there’s a type of stroke growing in popularity among pregnant women. It’s probably got a lot of expectant moms in a stir—but is it cause for panic?
The media buzz all began with a report that stated spontaneous subarachnoid hemorrhage (sSAH)—a rare type of stroke—is on the rise among pregnant women. The research was presented at a recent stroke conference.
First, let’s delve into the facts. An sSAH is a hemorrhage that is caused by a brain artery abnormality. It occurs when blood vessels on the surface of the brain wear down and rupture. That causes membranes surrounding the brain to bleed. All of this trauma happens without any actual head or neck trauma.
As for the research, scientists looked at data from 3,978 pregnant women who were treated for sSAH at hospitals during 2002 and 2014. They noted that percentage of women ages 15 to 49 being admitted for sSAH during that time span rose from 4 percent to 6 percent. Here’s something interesting—the biggest chunk of women, 20 percent of them—were in their 20s. The racial breakdown was also featured: 8 percent of women with sSAH were African-American, 7 percent were Hispanic and 4 percent were Caucasian.
Kaustubh Limaye, M.D., a clinical assistant professor at the University of Iowa in Iowa City and study author, did find that women who had the stroke and were pregnant had better outcomes compared to those who were not expecting. In fact, 8 percent of pregnant women died and 17 percent of non-pregnant women died from the stroke.
Cause for Concern?
What caused the surge in cases? Limaye said the possible increase in cases could be due to better imaging technology. As in, the technology to properly classify women with the stroke wasn’t as good in 2002 as it got by 2014.
Amelia Boehme, Ph.D., an assistant professor of epidemiology at Columbia University who studies stroke, noted that the study compared the percent of pregnant women among sSAH patients over time but did not account for the increasing numbers of pregnancies over time.
“The rise in the percent of sSAH patients who are also pregnant might be due to the rise in number of pregnancies,” she said. Boehme said it would be useful to look at the percentage of pregnant women who have sSAH, as this would determine whether sSAH is increasing in pregnant women over time.
Pregnancy Stroke Risks and Symptoms
Randolph S. Marshall, MD, chief of the stroke division at Columbia Presbyterian Medical Center, called the report a “concerning trend.”
“Women with pre-ecclampsia—spontaneous hypertension of pregnancy—are at particular risk for stroke, and this risk continues even in the few weeks after delivery,” he noted. “Hypertension prior to pregnancy increases the risk as well.”
“It is important for women who are pregnant to pay special attention to blood pressure because even women who never had high blood pressure may develop it during pregnancy,” Marshall added.
Regina S. Druz, M.D. a cardiologist from New York, said that even though strokes are rare, women should not ignore symptoms.
“Many symptoms in pregnancy, such as dizziness, shortness of breath, palpitations, occur commonly, making it difficult to recognize pathological conditions. Obviously, a pronounced symptom, such as a facial droop, difficulty with arm or leg movements, difficulty speaking, or disorientation, are serious concerns, and are not normal, in any patient,” she said, adding that women who experience those should seek immediate medical attention.
“Many women don’t realize that a sudden, severe headache can be a sign of a stroke, especially if it is combined with nausea or vomiting,” added Eliza Miller, M.D. an assistant professor of neurology at Columbia University Medical Center.
Vision loss, altered speech, sudden vision loss, or impaired balance are symptoms of stroke. Symptoms of sSAH also include a sudden severe headache or loss of consciousness, according to Aravind Ganesh, M.D., a doctor at the Center for Prevention of Stroke and Dementia at the University of Oxford.
Ganesh’s previous research found that women with hypertension in pregnancy, especially severe forms such as pre-eclampsia and eclampsia, are at higher risk of stroke during and beyond pregnancy compared to other women.