Sunday, July 31, 2011

Obesity a culprit as strokes rise in pregnant women

Written by Adam Tamburin | The Tennessean

The stroke rate for pregnant women and women who have recently given birth has increased by 54 percent since the mid-1990s, according to a new report that local physicians are greeting with alarm, if not surprise.

The report, released Thursday by the American Heart Association and the American Stroke Association, examined millions of patient discharge records in a national database culled from 1,000 hospitals. It found 4,085 hospitalizations because of pregnancy-related strokes from 1994-1995 and 6,293 of the same cases from 2006-2007.

These results come as no surprise to several local physicians, who say they have noticed an increase in risk factors for strokes, including obesity and high blood pressure, among their pregnant patients.

“It’s shocking, but it’s not surprising,” said Janice E. Whitty, director of maternal fetal medicine for Meharry Medical College.

“We’ve had a tremendous increase in obesity in pregnancy, and this, I think, is really driving this dreaded complication.”

Whitty said obesity among pregnant women often leads to high blood pressure and other complications that can increase the risk of a stroke.

Extra weight can add to risks

Cornelia Graves, medical director of the perinatal program at Baptist Hospital, said most of her hospital’s pregnant patients were obese before conceiving, a fact that is in keeping with Tennessee’s high obesity rate.

Graves said the added weight on most expectant mothers can exacerbate health risks pregnant women already face, as pregnancy often uncovers hereditary health issues that women have not yet encountered.

“Women come in with these histories of cardiovascular disease and diabetes and they come in 45 pounds heavier than their mothers were when they had children,” Graves said. “You already have genetic risk factors and then pregnancy unmasks these risk factors. And now you have this weight issue.”

Medications help

Whitty and Graves said this report’s findings are another indication of the nation’s struggle with obesity.

However, they said, they have not noticed a steep spike in pregnancy-related strokes.

Graves said this could be because of the aggressive treatment of high blood pressure in pregnant women in Middle Tennessee, and the TennCare program that offers health insurance to pregnant Tennesseans with low incomes.

About 60,000 women are enrolled in the program at a time, according to a TennCare spokeswoman.

Sometimes, Graves said, Baptist physicians put at-risk patients on several medications meant to combat high blood pressure.

“You’re not going to avoid every stroke, but those things can definitely help to turn the tide,” she said.

The key to avoiding strokes among at-risk women is the regular care of a physician, said Sanat Dixit, a neurosurgeon with Summit Medical Center and Cumberland Brain & Spine.

“Stroke in pregnancy could potentially be preventable if you can manage the risk factors properly,” he said. “Those risk factors can be mitigated with proper medical management.”

Whitty said obesity and added risk factors for stroke are especially prevalent among low-income patients, who might not have access to healthier food or might not view regular medical checkups as a necessity during pregnancy.

Preventive steps

Jessica Florida, vice president of physician recruitment for TriStar Health System, is due to give birth to her second child on Monday and is taking medication to fight her high blood pressure.

Although she doesn’t typically struggle with high blood pressure or obesity, Florida said, her blood pressure reached potential stroke levels in the days after the birth of her son in 2006.

“The blood pressure issue cropped up really quickly,” Florida said. “It was scary once I realized that my blood pressure was as high as it was.”

Florida credited her doctors and a more strenuous exercise regimen with defusing what could have been a deadly health hazard.

Whitty, Graves and Dixit all said that women should regularly monitor obesity, high blood pressure and other stroke risks — even if they aren’t pregnant.

“Many of those patients never see a physician until they get pregnant,” Graves said. “We need to close in that window and care for women … during those child-bearing years.”


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