Islam Elgendy, MD: Stroke Risk Among Pregnant Women

Cardiovascular risks, and even symptoms of major events, are famously underreported in female patients. And even now, in an era of advancing screening and treatment methods, the most susceptible female population is in need of prevention response.

New data presented at the American Heart Association (AHA) 2019 Scientific Sessions in Philadelphia this weekend showed a continuous trend of stroke risk in women during pregnancy and puerperium. The nationwide data findings are concerning—yet consistent with prevalence and mortality risk interpreted more than a decade ago.

In an interview with MD Magazine® while at AHA 2019, presenting author Islam Elgendy, MD, a vascular interventional fellow with Massachusetts General Hospital, detailed the study findings, and discussed steps toward stroke risk resolution in at-risk women.

MD Mag: What were the findings of the assessment into stroke risk among women during pregnancy and puerperium?

Elgendy: It's a nationwide study across the country. We looked into trends of the contemporary, recent data among pregnant women hospitalized for either their pregnancy or postpartum early condition.

We looked into the instance of stroke in those women. It was about .04%, which translates to about 1 of 2200 hospitalized women had a stroke. These trends, from 2007-2015, have not changed. In fact, they might be increasing—which is concerning owing to the fact that we know maternal mortality rate is going up in the United States compared to other developed countries, and cardiovascular disease is now the no. 1 cause of death among this group of women.

So, that was the synopsis of the study. We looked into further details—we found that risk factors of stroke are going up—hypertension, diabetes, obesity, hyperlipidemia. This is concerning, because the mean age of women was about 29 years.

We also found the maternal mortality rate of women who had a stroke was about 4%, and it was about 400 times more than a woman who did not have stroke, which is again concerning.

But the reassuring thing is we found trends of mortality are getting better. We're treating them better. But we're not doing our job to prevent this from happening.

MD Mag: How can cardiovascular-preventive measures improve in pregnant women?

Elgendy: First of all, we have to highlight the problem, correct? We know that this is a problem—even if they're young, they're still vulnerable to this. And it's a catastrophic event for them, both the mother and the child.

What we can do is highlight the problem, identify the risk factors, and start working on fixing those. So, we know from data from the general population, we have been working on improvement in traditional cardiovascular risk factors—hypertension, diabetes, smoking—but what we found in this population of women is these traditional risk factors are going up.

This means that we should be focusing on this group of women as, "Hey, this is something that we should fix and work on before getting pregnant."