title: Incidence, risk factors, management, and outcomes of stroke in pregnancy.
abstract: OBJECTIVE
  To estimate the incidence of antenatal stroke in the United Kingdom and to describe risk factors associated with stroke during pregnancy, management, and outcomes.
  
  
  METHODS
  A population-based (nationwide) cohort and nested case-control study was conducted using the UK Obstetric Surveillance System between October 2007 and March 2010. We investigated the potential factors associated with antenatal stroke using a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Thirty cases of antenatal stroke were reported giving an estimated incidence of 1.5 cases per 100,000 women delivering (95% CI 1.0-2.1). The incidences of nonhemorrhagic and hemorrhagic stroke were 0.9 (95% CI 0.5-1.3) and 0.6 (95% CI 0.3-1.0) per 100,000 women delivering. Factors associated with increased risk of antenatal stroke were history of migraine (adjusted OR 8.5, 95% CI 1.5-62.1), gestational diabetes (adjusted OR 26.8, 95% CI 3.2-∞), and preeclampsia or eclampsia (adjusted OR 7.7, 95% CI 1.3-55.7). There was wide variation in the use of pharmacologic, surgical, and organized stroke unit care. There were six stroke-related maternal deaths giving a case-fatality rate of 20% of all strokes, 50% of hemorrhagic strokes, and a mortality rate of 0.3 (95% CI 0.1-0.6) per 100,000 women delivering.
  
  
  CONCLUSIONS
  The risk of a stroke during pregnancy is low; however, the poor outcomes in terms of morbidity and mortality and variations in care highlight the importance of such women receiving specialist stroke care. Clinicians should be aware of an association with a history of migraine, gestational diabetes, and preeclampsia or eclampsia.
  
  
  METHODS
  II.
authors: National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom. cathy.a.scott@gmail.com
authors: Catherine A
authors: CA
authors: Scott
authors: Susan
authors: S
authors: Bewley
authors: Anthony
authors: A
authors: Rudd
authors: Patsy
authors: P
authors: Spark
authors: Jennifer J
authors: JJ
authors: Kurinczuk
authors: Peter
authors: P
authors: Brocklehurst
authors: Marian
authors: M
authors: Knight
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology