Stroke doesn’t happen just to “old people.” Young women are also at risk, particularly if they are pregnant—and the weeks just before and right after giving birth are especially dangerous. Alarming as this sounds, most of these strokes don’t have to happen if pregnant women and new mothers—and their doctors—take the right preventive measures.
Stroke is the fourth-leading cause of death for women, in part because even a seemingly healthy pregnancy can raise the risk for stroke. Levels of the hormone estrogen increase dramatically during pregnancy, and estrogen helps blood to clot. Pregnancy also increases the risk for two conditions that can lead to stroke—preeclampsia (characterized by high blood pressure and protein in the urine)…and eclampsia (characterized by high blood pressure, protein in the urine and seizures). Women who become pregnant after age 40 are at highest risk for both these conditions.
According to a recent study led by researchers at the Centre for Surveillance and Applied Research in Canada, stroke during the postpartum period (42 days after delivery) rose almost six percentage points in a little more than a decade—from 10.8 out of every 100,000 pregnancies to 16.6 out of every 100,000 pregnancies. Data from the US Nationwide Inpatient Sample from 1994 to 1995 and from 2006 to 2007 showed a 47% increase for hospitalizations during pregnancy and an 83% increase for postpartum hospitalizations associated with stroke. And a more recent Centers for Disease Control and Prevention (CDC) study published in Obstetrics and Gynecology found a 62% increase in strokes during pregnancy or after childbirth over a 17-year period.
Risk for the deadliest form of stroke, hemorrhagic, is highest during the third trimester of pregnancy through 12 weeks after giving birth, according to an American Heart Association study that looked at 3.3 million births over a 10-year period.
What You Can Do
Among the factors that might be driving the increase in pregnancy-related stroke is that more women are having children at older ages, and older age is a stroke risk factor in itself. But while it may not be an option to choose pregnancy at a younger age, other factors—primarily, high blood pressure—that can make a pregnant women stroke-vulnerable are preventable.
Stroke-prevention steps to take during and after pregnancy…
• Prioritize pre- and postnatal care. The American College of Obstetricians recommends that women have a follow-up visit with their doctors within three weeks postpartum. This is an update from their previous recommendation that a follow-up visit should happen six weeks postpartum. If you’re at high risk for stroke, you may need to check in even earlier than that.
• Check your blood pressure at least several times a week. Even if your numbers stay in the normal range, if there’s a significant increase—20 points or more in the systolic (upper) number—you should call your doctor. It’s especially important to check your blood pressure regularly if you were diagnosed with preeclampsia or eclampsia during or after pregnancy. Best type of blood pressure monitor: The American Heart Association (AHA) recommends an automatic upper-arm cuff-style monitor.
• Make time for your own health. Now that your baby is in your arms rather than your belly, it may seem as though, along with breast milk, your little bundle of joy sucks up all your time and energy. But you need to find time to take care of your own health, too. Eat a healthful diet (both Mediterranean and DASH diets are excellent for stroke prevention)…exercise regularly…take steps to manage stress…don’t smoke and avoid environmental tobacco smoke exposure…and avoid or limit alcohol.
Also, if you have been diagnosed with diabetes, or pregnancy caused your blood sugar to go into the diabetic range, take steps to keep your blood sugar at a healthy level. And if you’re overweight, discuss with your doctor safe, healthy ways to control your weight during pregnancy and shed pounds once your baby is born.
• Be alert to stroke symptoms. The acronym F-A-S-T, developed by the AHA, makes it easy to recognize the signs and get help immediately. It stands for Facial drooping…Arm weakness…Speech difficulty…and Time to call 911 right away! Also realize that stroke symptoms in women can be different from those in men.
• Discuss with your doctor whether you should take aspirin. Low-dose aspirin (81 mg/day) may have cardio-protective benefits for women at high risk for preeclampsia. However, aspirin can also increase risk for bleeding complications, so discuss the pros and cons with your obstetrician.
• Know your health history. Preexisting conditions, such as diabetes, heart disease, lupus, rheumatoid arthritis, blood-clotting disorders, atrial fibrillation (Afib) and irregular heartbeat, can increase risk for stroke. So can a history of multiple miscarriages. Be sure to discuss your whole health history during prenatal and postpartum checkups.