UI researchers find rare form of stroke increasingly being recognized in pregnancy

A UI Health Care research team presented findings this week at the American Stroke Association’s International Stroke Conference 2018 in Los Angeles, California, that show an uncommon kind of stroke is being increasingly recognized among pregnant women.

The rare type of stroke, called spontaneous subarachnoid hemorrhage or sSAH, is increasing among pregnant women, according to the UI’s preliminary results.

Spontaneous SAH occurs when arteries in the brain weaken and blood vessels on the surface of the brain rupture, causing bleeding between the membranes surrounding the brain. The study included non-traumatic cases alone.

The study compared how often these strokes occur among pregnant and non-pregnant women, and how the pregnant women were doing when they were discharged from the hospital.

After reviewing the records obtained for 3,978 pregnant women, age 15 to 49, from 2002 to 2014 researchers found:

• The percentage of pregnant women admitted to the hospital for sSAH increased from 4 percent to 6 percent.
• The proportion of pregnant women with sSAH was highest among African Americans at 8 percent, followed by Hispanics at 7 percent, and Caucasians at 4 percent.
• The percentage of pregnant women with sSAH was highest among 20- to 29-year-olds at 20 percent, and lowest among 40- to 49-year-olds at less than 1 percent.

“We need to increase awareness in the medical community about the increasing trend of spontaneous subarachnoid hemorrhage in pregnancy because management of these patients continues to be a clinical conundrum,” said study lead author Kaustubh Limaye, MD, clinical assistant professor in the Division of Cerebrovascular Diseases.

Pregnant women with sSAH had better outcomes than non-pregnant women with sSAH. Eight percent of pregnant women admitted to the hospital with stroke died, compared to 17 percent of non-pregnant women. Pregnant women also were more likely than non-pregnant women to be discharged from the hospital to home rather than to another health care facility.

“Pregnant women with spontaneous subarachnoid hemorrhage may have better outcomes than previously expected, which challenges prior findings from small, single-center reviews,” Limaye said.

The research team also included Achint Patel, MD, MPH; Sourabh Lahoti, MD; Cynthia Kenmuir, MD, PhD; James Torner, PhD; Edgar Samaniego, MD, MS; Santiago Ortega Gutierrez, MD, MS; David Hasan, MD; Ashutosh Jadhav, MD, PhD; Colin Derdeyn, MD; Tudor Jovin, MD; Harold Adams, MD; and Enrique Leira, MD, MS. Author disclosures are on the abstract.

The data came from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample, a national database that provides estimates of patients’ hospital stays. The database does not provide information about the severity of the stroke. Another limitation could be that some cases were incorrectly classified as strokes.

The National Institute of Neurological Disorders and Stroke partially supported Limaye’s salary.