title: Pregnancy and puerperium-related strokes in Asian women.
abstract: BACKGROUND
  Despite an increased risk of stroke in pregnancy and puerperium, the overall incidence of the condition in this population is low. Therefore, there is limited data pertaining to these patients particularly from Asian countries. Our objective was to describe the risk factors and outcomes of 110 pregnancy-related ischemic strokes from 5 Asian countries.
  
  
  METHODS
  Data were collected by retrospective chart review in most cases and prospectively in the rest. Inclusion criteria for this subanalysis were women, pregnant or within 1-month postpartum, presenting to the study center with acute ischemic stroke (arterial or venous) confirmed by neuroimaging. Intracranial hemorrhages other than the ones associated with cerebral venous thrombosis or hemorrhagic infarct were excluded. Risk factors were diagnosed based on already published criteria. Outcomes were measured using modified Rankin score. Statistical analysis was done using Statistical Package for Social Sciences version 19.0.
  
  
  RESULTS
  In all, 110 women with mean age of 27.94 years presented with pregnancy-related ischemic strokes; 58.2% of the strokes occurred postpartum and 49.1% were secondary to cerebral venous thrombosis. Venous strokes were significantly more likely to occur postpartum compared with arterial strokes (P=.01), to have abnormal "hypercoagulable panel result on admission" (P<.001), less likely to have traditional stroke risk factors (P<.001), to have hemorrhagic conversion of stroke (P<.001), and to have lesser stroke severity and better functional outcome at 3 months (P<.001 for each).
  
  
  CONCLUSIONS
  Cerebral venous thrombosis is a significant contributor to pregnancy-related strokes in Asian women. Both traditional and pregnancy-specific risk factors should be addressed to control ischemic stroke risk in these women.
authors.affiliation: Department of Medicine/Neurology, Aga Khan University, Karachi, Pakistan.
authors.forename: Maria
authors.initials: M
authors.lastname: Khan
authors.forename: Mohammad
authors.initials: M
authors.lastname: Wasay
authors.forename: Bindu
authors.initials: B
authors.lastname: Menon
authors.forename: Mohammad
authors.initials: M
authors.lastname: Saadatnia
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.forename: Padma
authors.initials: P
authors.lastname: Gunaratne
authors.forename: M M
authors.initials: MM
authors.lastname: Mehndiratta
authors.forename: Alper
authors.initials: A
authors.lastname: Dai
authors.forename: Subhash
authors.initials: S
authors.lastname: Kaul
mesh_terms: D000328:Adult; D001208:Asia / Q000453:epidemiology; D044466:Asian People; D002545:Brain Ischemia / Q000453:epidemiology; D002536:Cerebral Arteries / Q000473:pathology; D002550:Cerebral Veins / Q000473:pathology; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000473:pathology; D016896:Treatment Outcome
keywords: Asian; Stroke; cerebrovascular disease; female; post partum; pregnancy; puerperium; women