By Hwaa Irfan
For reasons that have yet to be ascertained, more and more young expectant mothers have been experiencing pregnancy stroke in the U.S.
In a recently published study of a national database of 5 to 8 million discharges the rates of strokes from 1994-1995 and 2006-2007 in women who were pregnant was reviewed. Between 1884 – 2007 from 4,085 – 6,293 annually registering a 54% increase of hospitalized cases.
The reasons identified so far by the medical researchers are pre-stroke factors: high blood pressure, and obesity according to a recent study in Stroke: Journal of the American Heart Association. However, other experts refer to any factor that affects changes in hormonal levels including oral contraceptives.
A 1996 study published in the New England Journal of Medicine tracked patients aged 15 – 44 in Washington D.C. who were discharged from 1988 – 1991. Of those women, there were 17 cerebral infarctions, 14 intracerebral haemorrhages in pregnancy stroke related cases. There were also 175 cerebral infarctions and 48 intracerebral haemorrhages in non-pregnancy stroke related cases. Cerebral infarction is a disturbance in the blood vessels that supply the brain, and intracerebral haemorrhage is haemorrhaging in the brain tissues. They found that the risk of cerebral infarction increased by 8.7% in postpartum period, and 28.3% for intracerebral haemorrhaging with a risk of 8.1% per 1000 pregnancies.
In the above study it was found that intracerebral haemorrhaging was most common amongst women who had had induced abortion or who experienced a stillbirth, with the natural and induced abortions occurring before the stroke. However, focusing on the stillbirths, foetal death happened before or at the time of the stroke with the stroke taking place before delivery. However, the conclusion was that it was the postpartum state rather than pregnancy itself that was the risk factor for cerebral infarction and, intracerebral hemorrhage
In a Danish study of the same age group of 497 females who had cerebral thromboembolic attacks the risk factor of oral contraceptives was factored in. Of these women, 13 were pregnant with an additional randomly selected 1370 females as a control.
A 1997 U.K., study by the Department of Clinical Neurosciences of the Royal Free Hampstead NHS Trust, it was found that out of 3300 births pregnancy-related stroke was likely to occur in every 9 months to 2 years. In other words, at that time pregnancy stroke was considered rare, however, they also found that thromboembolism was more likely to occur postpartum, and was the leading cause of maternal death. Intracerebral haemorrhage only occurred in 9 out of 100 000 deliveries, and again with the highest risk occurring postpartum. Referring to a Swedish study of 650,000 women in an 8-year period it was found that ischemic and intracerebral haemorrhaging occurred 2 days before or 1 day after delivery increasing postpartum. It was also found that pregnancy stroke occurred more amongst
- black women
- Over 35
- Those with no pre-natal care
- 3 – 12 times higher amongst caesarean births
- Those with diabetes
- Those with Sickle cell anemia
- Those with Lupus
- Those with Thrombophilia
- Those with pre-eclampsia
- Those who smoke
- Those with heart disease.
The same study showed that most venous events occurred in the puerperium. A large Swedish cohort of more than 650 000 women with more than 1 million deliveries in an 8-year time period concluded that the greatest risk of ischemic and haemorrhagic cerebral events was in the 2 days before and 1 day after delivery, with an increased, but declining risk over the subsequent 6-week postpartum period.
At the La Rabata Teaching Hospital in Tunisia, pregnancy stroke accounted for 12% of maternal deaths as defined by a retrospective analysis of 88 patients from 1996 – 2009. Fifty four women were identified as experiencing pregnancy stroke and of those 30 suffered ischemic stroke, and 24 with intracranial haemorrhaging. The cause of ischemic stroke was identified as pre-eclampsia, deficiency of protein C, and venal thrombosis in 11 patients. Nine patients were identified with valvular heart disease with a history of stroke in 4 patients. The maternal deaths were 19 of which 8 had cerebral infarction, and 11 had intracranial haemorrhaging. Nationwide, maternal deaths are 35%.
What to Do
A stroke can happened suddenly with the following symptoms:
- Dizziness followed by nausea
- Vomiting followed by fatigue
- One-sided paralysis
- Difficulty in breathing
- Rapid pulse
All the underlying factors that contribute to a stroke point to the importance of having a healthy lifestyle. This means spending less time sitting and more time being physically active bodies are designed for physical and not a sedentary lifestyle. Even if one does not feel at liberty to go and for long walks due to the level of security and safety in one’s locality, activities within the home which have been placed under remote control should be reviewed. Of course there are additional activities like dance, yoga, swimming, and exercise that one can take time out to do, but naturally physically active creates a normal physically active lifestyle.
Then of course there is diet, which should include a variety of fresh, unprocessed foods from grains, to vegetables, pulses, nuts, berries and natural homemade drinks that do not come in a can. It has already been identified that the Western diet which is essentially processed ready-made foods is the main culprit behind the global rise in obesity, which along with the remote control highlights how our lives were never meant to be ‘convenient.’
Calcium – regulates circulatory diseases as an alkaline that counters acidity in the blood, and debris that may accumulate and block arterial walls.
Potassium – acts as an antidote against
Hawthorn Berries – boosts circulation, regulates high blood pressure and strengthens the blood vessels, reduces blood clots, and lowers bad cholesterol. Bought/picked fresh they can be added to the morning breakfast, muesli, fruit salads, or eaten as snacks.
Carrots – reduces risk of stroke when it forms parts of a daily diet
Spinach – shares in common with dark green vegetables, and orange coloured vegetables and fruits beta carotene also reduces the risk of stroke when it forms a part of the daily diet.
The process of birthing for many women has become a traumatic experience in hospital, and may be a contributory factor in pregnancy strokes yet unidentified. For years, those who can find alternative, more therapeutic methods of delivery do so in order to enjoy the experience, and increase bonding with their newborn child. Another factor is that because the female energy has become so suppressed over decades that a woman may ‘detach’ herself from her body through a process of objectification. Pregnancy though natural, may introduce a woman to her body in away totally unexpected, which makes practices like yoga, movement, and forms of dance like oriental dancing an important tool in re-establishing an equilibrium between a woman’s ‘ideal self’, and her ‘true self.’ By re-establishing this balance, a woman will experience less gender-related illnesses, and more hormonal balance.
Kittner, J. S. et al. Pregnancy and the Risk Of Stroke.” N Engl J Med. 1996 September 12; 335(11): 768–774. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479545/
Lakhdar, R et al. “Etiology and Outcome of Stroke in Pregnancy.” http://spo.escardio.org/eslides/view.aspx?eevtid=40&fp=P3044
O’Brien, C.A.D. “Pregnancy and Neurology: Stroke and Pregnancy.” J Neurol Neurosurg Psychiatry 2008;79:240-245 doi:10.1136/jnnp.2007.116939
“Stroke Risk Rising Among Pregnant Women in Alarming Rate: Study.” http://www.ibtimes.com/articles/189420/20110729/stroke-risk-rising-among-pregnant-women-in-alarming-rate-study.htm