04:43am Tuesday 12 December 2017

Stroke Risk in Pregnant Women 2.4 Times Higher, Loyola Researchers Report

Pregnant women face a risk of stroke that is 2.4 times higher than the risk in nonpregnant women, according to a medical journal article by Loyola University Health System researchers.

The review article on pregnancy-induced high-blood-pressure syndromes is published in the journal Women’s Health.

“Prompt diagnosis and identification of patients at risk allows for early therapeutic interventions and improved clinical outcomes,” the Loyola authors wrote.

Pregnancy-induced high-blood-pressure syndromes include pre-eclampsia, eclampsia and a rare but serious illness called HELLP (hemolysis, elevated liver enzymes and low platelet count).

Pre-eclampsia is a multisystem disorder characterized by high blood pressure (top or bottom numbers equal to or greater than 140/90, when measured on two occasions six hours apart) and proteinuria (excess protein in urine — more than 300 mg. in 24 hours).

Left untreated, pre-eclampsia can cause serious complications, possibly fatal, in the mother and baby. In severe pre-eclampsia, patients may develop oliguria (reduced urine output), pulmonary edema (fluid in the lungs), liver dysfunction, thrombocytopenia (low platelet count) and changes in mental status and other cerebral symptoms. Patients may have headaches, stupor, visual blurring, blindness (often temporary) or seizures.

Pre-eclampsia can progress to eclampsia or HELLP. Pre-eclampsia develops into eclampsia when a patient experiences convulsive seizures or goes into a coma. HELLP can cause bleeding, liver problems and high-blood-pressure problems, harming both mother and baby.

“Pre-eclampsia/eclampsia-related events are a major cause of maternal disability and maternal and fetal death in the USA, and without prompt and aggressive treatment these patients may rapidly decline,” the Loyola authors wrote. All four are neurologists in the Loyola Stroke Program.

For pregnant women who have pre-eclampsia risk factors, starting aspirin at 12 to 14 weeks may decrease the risk of pre-eclampsia and death of the baby.

Once a patient is diagnosed with pre-eclampsia/eclampsia, physicians attempt to control blood pressure and seizures and manage brain swelling. “Prompt delivery of a viable baby remains the main and only curative therapeutic intervention,” the authors wrote.

Women who have pre-eclampsia are at higher risk for future stroke and cardiovascular disease.

The researchers wrote that identifying patients at risk of pregnancy-induced high-blood-pressure syndrome remains “a major research focus.”

The authors are in the Department of Neurology of Loyola University Chicago Stritch School of Medicine. They are Sarkis Morales-Vidal, MD (first author); Michael Schneck, MD; Murray Flaster, MD; and senior author José Biller, MD. Morales is an assistant professor, Flaster is an associate professor, Schneck is a professor and Biller is a professor and department chairman.

Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 22 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 569-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children’s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola’s Gottlieb Memorial Hospital campus in Melrose Park includes the 264-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.


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