May is National Stroke Awareness Month: Texas Children’s Pavilion for Women Shines Light on Stroke Risks in Pregnant Women

Dr. Avni Kapadia, Chief of Adult Neurology Service at Texas Children’s Hospital and Assistant Professor of Neurology, Division of Neurocritical Care and Vascular Neurology at Baylor College of Medicine, offers women advice for Stroke Awareness Month.

By Dr. Avni Kapadia

Strokes can happen to anyone, at any age. But some populations have a much higher risk of stroke, depending on several factors. Women, and especially pregnant women, have significant and unique risk factors. In fact, according to the CDC, 1 in every 5 women in the US will have a stroke.

This statistic usually surprises my patients, and they are not alone. Many women remain unaware of their stroke risk, and yet stroke is the No. 3 cause of death in women, killing over 90,000 women every year. The good news is that 4 in 5 strokes are preventable. That’s why it’s important for patients to understand their risk factors and take preventive actions to protect their health.

What is a stroke?

A stroke occurs when blood flow to the brain is blocked or when there is bleeding in the brain. In both cases, brain cells will start to die within minutes. As a result, strokes can cause permanent brain damage that results in long-term disability or even death. There are two types of stroke:

Ischemic stroke

This type of stroke is caused by blood clots or particles blocking the flow of blood to the brain. Fatty deposits, called plaque, can also build up in the blood vessels and cause blockages.  

Hemorrhagic stroke

This type of stroke is caused by bleeding in the brain. This puts too much pressure on brain cells and damages them.

In addition, there is something called ‘transient ischemic attack’ (TIA), which is otherwise known as a “mini-ischemic stroke.” It differs from ischemic stroke in that blood flow to the brain is blocked for only a short time. For this reason, TIAs are sometimes referred to as “warning strokes.” However, a TIA is still a medical emergency, just like a major stroke. Nearly 1 in 5 people who have a suspected TIA will have a stroke within 90 days, and 2 in 5, when given the appropriate scan, will learn that they actually had a stroke instead of a TIA. Recognizing and treating TIAs can both prevent lasting damage and lower the risk of a major stroke.

What are the symptoms?

When to seek emergency help?

To help stroke patients get the life-saving treatment they need, a helpful acronym is to act F.A.S.T. 

This refers to performing the following test:

• Face: Ask them to smile. Does one side of the face droop?
• Arms: Ask them to raise both arms. Does one arm drift downward?
• Speech: Ask them to repeat a simple phrase. Is the speech slurred or strange?
• Time: If you see any of these signs, call 9-1-1 right away.

Women and stroke

At Texas Children’s joint Maternal Fetal Medicine-Neurology Clinic, we see a number of pregnant women who have strokes. Our maternal-fetal medicine (MFM) doctors are Ob/Gyns who work alongside our BCM Neurologists to provide specialized neurologic care, and our multidisciplinary team is experienced in evaluating, diagnosing and treating strokes in pregnant women. Our specialists also conduct research and train the next generation of MFM doctors, staying at the forefront of high-risk pregnancy care. Our ability to deliver comprehensive care at our site — psychiatry, neurology, cardiologists in-house, etc. — is very helpful for both the mom and the baby.

It’s important for women to understand their risk factors. About 55,000 more women than men have a stroke each year. Among women, pregnant women are three times more likely to have a stroke and black women have the highest prevalence of stroke. Stroke risk increases in women who have preeclampsia, take birth control pills, use hormone replacement therapy, have migraines or atrial fibrillation and experience pregnancy at an advanced age (generally, over the age of 35).

Below is a breakdown of some risk factors associated with stroke, as explained by the American Heart Association.

• Pregnancy. Pregnant women are three times more likely to have a stroke as women of the same age.
• Preeclampsia. High blood pressure during pregnancy doubles stroke risk later in life.
• Birth control pills. Some medications can double the risk of stroke, especially in women with high blood pressure.
• Hormone replacement therapy. It doesn’t lower the risk of stroke, as once thought.
• Migraines with aura and smoke. Strokes are more common in women who have migraines with aura and smoke, compared with other women
• Atrial fibrillation. This quivering or irregular heartbeat can increase stroke risk fivefold. After age 75, it’s more common in women than men.

Texas Children’s Maternal Fetal Medicine Center

At Texas Children’s Pavilion for Women, the Maternal-Fetal Medicine Center offers specialized care to keep you and your baby safe throughout pregnancy and delivery. Women with high-risk pregnancies may need extra care before, during and after they give birth to keep them as healthy as possible. This May, let’s spread the word about National Stroke Awareness Month, because awareness can be truly life-saving — timely treatment can mean the difference between successful recovery and long-term disability. It’s crucial for women to be aware of their increased risk and how to prevent it. Talk to your health care provider about how to lower your risk and use the American Heart Association/American Stroke Association prevention guidelines.

Learn more about Texas Children’s Pavilion for Women and the Maternal Fetal Medicine Center. To contact the team, call 832-826-4636.