Stroke in pregnancy and postpartum: Etiology, incidence, and risk factors in a tertiary care cohort.

BACKGROUND

Stroke during pregnancy and the puerperium is rare but potentially devastating, contributing substantially to maternal morbidity, mortality, and adverse fetal outcomes. Data on incidence, etiology, and modifiable risk factors in low- and middle-income countries remain limited.

METHODS

We retrospectively reviewed medical records of women ≥ 18 years admitted with ischemic stroke (arterial or cerebral venous thrombosis) or hemorrhagic stroke during pregnancy or up to 12 weeks postpartum at Harran University Hospital between January 2013 and October 2024. Clinical features, neuroimaging findings, laboratory parameters, thrombophilia/genetic testing, and obstetric complications were analyzed. A control group comprised age-matched pregnant/postpartum women hospitalized for obstetric indications without stroke. Risk factors were compared between groups, and center-based incidence was calculated per 100,000 deliveries.

RESULTS

Eighty-three women were included (25 pregnant, 58 postpartum). Ischemic stroke predominated over hemorrhagic events. Cerebral venous thrombosis was the most frequent subtype, particularly postpartum and within 6 weeks of delivery. Preeclampsia/eclampsia and anemia were significantly more common in cases than controls (p < 0.01). Laboratory abnormalities included higher urea, creatinine, glucose, low-density lipoprotein cholesterol, C-reactive protein, erythrocyte sedimentation rate, red cell distribution width, and platelet counts, with lower hemoglobin, ferritin, albumin, thyroid-stimulating hormone, and mean corpuscular volume. Thrombophilia testing revealed higher frequencies of methylenetetrahydrofolate reductase C677T/A1298C, prothrombin G20210A, and Factor V Leiden variants among cerebral venous thrombosis patients. The incidence of pregnancy-associated stroke at our center was 57.8 per 100,000 deliveries.

CONCLUSIONS

Pregnancy-associated stroke, especially postpartum CVT, remains an important cause of maternal morbidity. Hypertensive disorders and anemia emerged as key modifiable correlates. Early postpartum surveillance, blood pressure control, treatment of anaemia, and risk-tailored thromboprophylaxis may reduce the burden of maternal stroke.