Incidence and Etiologies of Stroke during Pregnancy and Puerperium as Evidenced in Taiwanese WomenJeng J.-S. · Tang S.-C. · Yip P.-K.
Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: Pregnancy is a known risk factor for stroke, but relatively few studies have been conducted in Asian populations to document the risk. This study aimed to analyze the incidence and etiologies of stroke occurring during pregnancy and puerperium in Taiwanese women. Methods: From 1984 to 2002, female patients 15 through 40 years of age with first-ever stroke during pregnancy or within 6 weeks of delivery were recruited. Stroke was classified as ischemic stroke (IS), cerebral venous thrombosis (CVT), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). The incidence, time of stroke onset (1st through 3rd trimester or puerperium), and etiologies of different stroke subtypes were analyzed. Results: Of 402 young female stroke patients, 49 had stroke during pregnancy and puerperium, including 16 with IS, 11 with CVT, 19 with ICH and 3 with SAH. After excluding referral patients, the incidences of pregnancy-related stroke were 46.2 (95% CI 30.7–69.5) per 100,000 pregnancies. 67% developed stroke in the 3rd trimester and puerperium, and 73% of CVT occurred in the puerperium period. Etiologies were well defined in 78% of patients. Eclampsia (37%) and arteriovenous malformation (26%) were the most important etiologies of ICH. For IS and CVT, rheumatic heart disease (44%) and coagulopathy (64%) were the major etiologies respectively. Conclusions: The incidence of stroke occurrence during pregnancy and puerperium in Taiwanese women is higher than that of Caucasian populations; the majority of strokes occurred in the 3rd trimester and puerperium, particularly CVT.
© 2004 S. Karger AG, Basel
- Mas JL, Lamy C: Stroke in pregnancy and the puerperium. J Neurol 1998;245:305–313.
- Knepper LE, Giuliani MJ: Cerebrovascular disease in women. Cardiology 1995;86:339–348.
- Wiebers DO, Whisnant JP: The incidence of stroke among pregnant women in Rochester, Minn, 1955 through 1979. JAMA 1985;254:3055–3057.
- Sharshar T, Lamy C, Mas JL: Incidence and causes of strokes associated with pregnancy and puerperium. A study in public hospitals of Ile de France. Stroke 1995;26:930–936.
- Kittner SJ, Stern BJ, Feeser BR, Hebel JR, Nagey DA, Buchholz DW, Earley CJ, Johnson CJ, Macko RF, Sloan MA, Wityk RJ, Wozniak MA: Pregnancy and the risk of stroke. N Engl J Med 1996;335:768–774.
- Lanska DJ, Kryscio RJ: Stroke and intracranial venous thrombosis during pregnancy and puerperium. Neurology 1998;51:1622–1628.
- Simolke GA, Cox SM, Cunningham FG: Cerebrovascular accidents complicating pregnancy and the puerperium. Obstet Gynecol 1991;78:37–42.
- Witlin AG, Friedman SA, Egerman RS, Frangieh AY, Sibai BM: Cerebrovascular disorders complicating pregnancy – beyond eclampsia. Am J Obstet Gynecol 1997;176:1139–1148.
- Jaigobin C, Silver FL: Stroke and pregnancy. Stroke 2000;31:2948–2951.
- Caplan LR, Gorelick PB, Hier DB: Race, sex and occlusive cerebrovascular disease: A review. Stroke 1986;17:648–655.
- Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, Caplan LR: Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 1990;40:1541–1545.
- Jeng JS, Lee TK, Chang YC, Huang ZS, Ng SK, Chen RC, Yip PK: Subtypes and case-fatality rates of stroke: A hospital-based stroke registry in Taiwan (SCAN-IV). J Neurol Sci 1998;156:220–226.
- Yip PK, Jeng JS, Lee TK, Chang YC, Huang ZS, Ng SK, Chen RC: Subtypes of ischemic stroke. A hospital-based stroke registry in Taiwan (SCAN-IV). Stroke 1997;28:2507–2512.
Greenland S, Rothman KJ: Introduction to categorical statistics; in Rothman KJ, Greenland S (eds): Modern Epidemiology, ed 2. Philadelphia, Lippincott-Raven, 1998, pp 231–252.
- Wiebers DO: Ischemic cerebrovascular complications of pregnancy. Arch Neurol 1985;42:1106–1113.
- Ros HS, Lichtenstein P, Bellocco R, Petersson G, Cnattingius S: Increased risks of circulatory diseases in late pregnancy and puerperium. Epidemiology 2001;12:456–460.
- Neto JIS, Santos AC, Fabio SRC, Sakamoto AC: Cerebral infarction in patients aged 15–40 years. Stroke 1996;27:2016–2019.
- Cantú C, Barinagarrementeria F: Cerebral venous thrombosis associated with pregnancy and puerperium: Review of 67 cases. Stroke 1993;24:1880–1884.
Srinvasan K: Ischemic cerebrovascular disease in the young: Two common causes in India. Stroke 1984;15:733–735.
- Ferro JM, Correia M, Pontes C, Baptista MV, Pita F for the Cerebral Venous Thrombosis Portuguese Collaborative Study Group (Venoport): Cerebral vein and dural sinus thrombosis in Portugal: 1980–1998. Cerebrovasc Dis 2001;11:177–182.
- Cerneca F, Ricci G, Simeone R, Malisano M, Alberico S, Guaschino S: Coagulation and fibrinolysis changes in normal pregnancy: Increased levels of procoagulants and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibrinolysis. Eur J Obstet Gynecol Reprod Biol 1997;73:31–36.
- Sibai BM, Frangieh A: Maternal adaptation to pregnancy. Curr Opin Obstet Gynecol 1995;7:420–426.
- Brady K, Duff P: Rheumatic heart disease in pregnancy. Clin Obstet Gynecol 1989;32:21–40.
- Lue HC, Tseng WP, Lin GJ, Hsieh KH, Hsieh RP, Chiou JF: Clinical and epidemiological features of rheumatic fever and rheumatic heart disease in Taiwan and the Far East. Indian Heart J 1983;35:139–146.
- North RA, Sadler L, Stewart AW, McCowan LM, Kerr AR, White HD: Long-term survival and valve-related complications in young women with cardiac valve replacement. Circulation 1999;99:2669–2676.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.