MedicalResearch.com Interview with:
Eliza Miller, M.D.
Vascular neurology fellow
New York-Presbyterian Hospital/Columbia University Medical Center
New York City
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Preeclampsia is a common disorder that causes high blood pressure during pregnancy. It affects about 1 in 20 pregnant women. Women with preeclampsia are at higher risk for stroke during pregnancy and post-partum, but it’s very difficult to predict who is going to have a stroke. Our study looked at a large dataset of billing data from New York State, and compared women who had preeclampsia and strokes to women who had preeclampsia but did not have a stroke.
We found that preeclamptic women with urinary tract infections, bleeding or clotting disorders, or preexisting high blood pressure were at higher risk of having strokes during pregnancy or postpartum.
MedicalResearch.com: What should readers take away from your report?
Response: It’s very important to note that two thirds of the strokes occurred postpartum, after women delivered their babies. Most of them happened after women had been discharged home from the hospital. Women are vulnerable during this time because the focus has shifted from their own health to the health of their newborn baby. Having a newborn is stressful for everyone, and many women with preeclampsia have the added stress of a premature baby who may still be hospitalized. Women may ignore stroke symptoms — for example, severe headache, vision changes, difficulty speaking — and not seek medical attention. Doctors need to talk to women with preeclampsia before they leave the hospital about their risk of stroke, make sure they understand the signs and symptoms of stroke, and emphasize the urgency of getting immediate medical attention. These can be devastating events. Of the women in our study who had strokes, more than one in ten died in the hospital.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We still don’t really understand what causes preeclampsia and what all its effects are, particularly on the brain. The infection piece is really interesting — why would having a urinary tract infection put a woman at higher risk for having a stroke? Other research has shown that infections can trigger strokes, especially in younger patients. Preeclampsia has inflammatory effects — maybe infections could exacerbate that effect. There is so much we don’t know about this disease, and it’s going to take a multidisciplinary approach to figure it out.
Disclosures: I receive fellowship support through an NIH NINDS StrokeNet Training Grant.
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Eliza C. Miller, Hajere J. Gatollari, Gloria Too, Amelia K. Boehme, Lisa Leffert, Randolph S. Marshall, Mitchell S.V. Elkind, Joshua Z. Willey. Risk Factors for Pregnancy-Associated Stroke in Women With Preeclampsia. Stroke, 2017; STROKEAHA.117.017374 DOI: 10.1161/STROKEAHA.117.017374
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