Stroke in Pregnancy

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Key points

Stroke is an important cause of severe maternal morbidity and mortality in the UK.
The increasing age of women at childbirth, along with other risk factors, may lead to an increase in the incidence of stroke associated with pregnancy.
There have been no prospective national studies to estimate the incidence or outcomes of this condition.
This study will investigate the incidence, risk factors, management and outcomes of stroke in pregnancy in the UK in order to inform future guidelines for prevention and treatment.

Surveillance Period

October 2007 - October 2009

Background

The decreasing incidence of direct causes of maternal death over the past half century has led to a heightened awareness of non-obstetric factors responsible for maternal mortality^[1]. While stroke associated with pregnancy is rare (estimates of incidence from retrospective studies vary from 3 to 30 per 100,000 pregnancies), the last seven Confidential Enquiries into Maternal Deaths report 144 deaths from stroke associated with pregnancy. In addition to premature death, stroke associated with pregnancy causes ongoing disability in many survivors, which has a serious impact for mother and infant, and on families, caregivers, and health services. Several population based studies suggest that there is an increase in the rate of all forms of stroke during the puerperium, but not during pregnancy itself^[2], however the estimates of incidence from different studies vary widely. The larger studies, based on administrative datasets are subject to coding errors, and can not collect information on individual cases, whilst the smaller studies are based on very few cases, and often recruit from specialist referral centres where incidences are higher, and estimates of the denominator population may be inaccurate.

As the age of women childbearing increases, alongside an increase in other vascular risk factors, the incidence of stroke pregnancy may be increasing. By prospectively collecting data on maternal stroke this study will provide valuable information into the epidemiology of stroke associated with pregnancy.

Objectives

To use the UK Obstetric Surveillance System to describe the epidemiology of antenatal stroke in the UK.
To use the results of this study to make practical improvements in prevention, treatment and service planning for stroke associated with pregnancy.

Research questions

What is the current incidence of antenatal stroke in the UK?
Which types of stroke (ischemic, haemorrhagic, venous thrombosis) affect women in pregnancy?
What are the risk factors for stroke in pregnancy (case control)?
How is stroke in pregnancy managed?
What is the prognosis of stroke in pregnancy for the mother and infant?

Case Definition

All women in the UK identified as having a stroke during pregnancy.

To be included as a case the stroke must

EITHER Be confirmed at postmortem

OR Be confirmed by a consultant neurologist or physician

OR Be confirmed by diagnostic testing (e.g. MRI/CT)

Funding

Wellbeing of Women.

Ethics approval

The study has been approved by the London MREC (study ref 07/H0718/54).

Investigators

Susan Bewley, Guys and St Thomas' NHS Foundation Trust
Cathy Scott, NHS Oxford Deanery
Anthony Rudd, Beverley Hunt, Charles Wolfe, Guys and St Thomas' NHS Foundation Trust
Marian Knight, NPEU

Download the Data Collection Form (DCF)

UKOSS Stroke in Pregnancy Form

References

^{^}Confidential Enquiry into Maternal and Child Health. Why women die 2000-2002. London: Royal College of Obstetricians and Gynaecologists, 2004.
^{^}Kittner S, Stern B, Feeser B, et al. (1996) Pregnancy and the risk of stroke. N Engl J Med;335:768-74.

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