Integrated Medicine, University Hospitals of Leicester NHS

Stroke is a recognised complication of pregnancy, contributing to more than 12 % of all maternal deaths. Estimated incidence rates vary considerably from 4.3 to 210 strokes per 100 000 deliveries. Atherosclerosis is rare in young adults, and so other causes of stroke become increasingly likely. Aetiological factors important in pregnancy include hypercoagulability due to maternal physiological changes, pre-eclampsia and eclampsia, cerebral venous thrombosis, paradoxical embolism, postpartum cerebral angiopathy and peripartum cardio-myopathy. Management of patients with pregnancy-related stroke should generally proceed as for non-pregnant patients, although there are a number of important areas specific to pregnancy which will be considered here. Stroke in young adults aged 15–35 years is more common in women than in men,1 and women also have poorer outcomes in terms of disability and dependency.2 There has been growing interest in the role of oestrogens in stroke,3 and risk factors unique to women include pregnancy, use of oral contraceptives, and postmenopausal hormone therapy. Stroke associated with pregnancy has been recognised for many years, and is an uncommon but feared complication contributing to more than 12 % of all maternal deaths.4 5 The declining incidence of direct causes of maternal death has led to an increased awareness of non-obstetric factors such as stroke. Clearly, any recognised cause of stroke in young patients may also occur coincidentally during pregnancy, although there are a number of factors associated with pregnancy that have an important aetiologi-cal role, and these will be considered here. We will also consider the current scope of the problem, and focus on relevant areas unique to pregnancy, including issues surrounding investigation and treatment options