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A stroke in pregnancy

Exhausted and focused on her newborn, Eva did not realize she was experiencing signs of stroke
Eva and her son

Eva with her son, Yiannis, now age six.

Eva Apatsidou Maragkakis was overjoyed to be expecting her first child at age 35.

But when giving birth to her son, she felt something was not quite right. She felt a lot of pressure in her head. She assumed that it was related to the delivery and the epidural anesthetic.

At home, learning to breastfeed her newborn, Eva’s headache persisted. “I felt tired — really, really tired.” Her arm became weak. “I felt like I was going to drop the baby,” she recalls. She kept taking the pain medications she had been given at the hospital.

“Nobody had mentioned to me that I was supposed to take the pills only for a few days. So two weeks later, I was still taking them. But not for any vaginal pain, mostly for my head.”

Along with the pain, she experienced vision problems and some confusion in her speech. “It was very difficult for me to read texts, or read anything. Then one night, I couldn’t see anything but white.”

Eva’s husband took her to emergency. “As soon as he told them I was postpartum, they took me straight in and took my blood pressure.”

Brain imaging tests revealed that she had had a stroke.

Stroke risk increases in pregnancy

About 30 out of every 100,000 women experience a stroke during pregnancy. It can happen at any stage, but the risk is highest just before or following birth.

“Pregnant women are at an increased risk of stroke, but it is important to stress that the risk is still very low,” says Dr. Richard Swartz, a stroke neurologist who helped care for Eva after her stroke. He is director of the Stroke Research Unit at Toronto’s Sunnybrook Health Sciences Centre.

 

I know my own body and I knew something was wrong but I was confused.

Eva Apatsidou Maragkakis

 
Dr. Swartz co-authored a 2017 study, funded by Heart & Stroke donors, which revealed that stroke in women during pregnancy is three times higher than in non-pregnant women of the same age. He says many women have headaches and feel tired when they have a new baby, but Eva’s persistent and worsening symptoms — especially those affecting speech, vision and weakness — highlight how stroke is different. It is important for women to advocate for themselves, he says, and seek help if they experience unusual symptoms that do not go away.

 “I know my own body and I knew something was wrong but I was confused,” Eva says. “I was tired and trying to focus on the baby. Women should know about the signs of stroke, and so should the people around them.”

Understanding risk factors

Further study is needed to understand more about why the risk of stroke increases in pregnant women. But early evidence shows that pre-eclampsia and eclampsia — problems in pregnancy involving high blood pressure and other symptoms — are the strongest risk factors, accounting for up to half of all strokes that occur in pregnancy.

They also put women at risk for developing stroke and heart disease later in life, and double their risk of dying prematurely from stroke and heart disease.

Right now, however, it’s difficult to accurately predict which women with pre-eclampsia have the highest risk of stroke. In Eva’s case her blood pressure was in control until delivery.

Recovery and beyond

Eva continued to see Dr. Swartz regularly for the year after her stroke, taking medication to stabilize her blood pressure.

Today, six years later, Eva is functioning well, and doctors keep a close watch on her blood pressure and other stroke risk factors. She works full-time as an architect, and does not have any paralysis. However, she notices some changes in her cognitive ability.

“I was always really strong in math, really fast. And now, when my son asks me a math question, I have to stop and focus and double check because I’m not sure if my answer is right.”

<p>Eva and her family shortly after Yiannis’s birth.</p>

Eva and her family shortly after Yiannis’s birth.

Eva and her husband, while raising a happy, healthy son, have made the decision not to risk another pregnancy. “It is more important for us to all be here together than to have a second child,” she says.

Meanwhile Dr. Swartz is working with Heart & Stroke to publish a consensus statement based on current evidence, to help other physicians, nurses and members of the healthcare team know how to help a woman who experiences a stroke during pregnancy, and during future pregnancies after their stroke.

He emphasizes the importance of collaboration between stroke specialists and experts in obstetrics and maternal-fetal medicine, so they can work together to ensure the best outcomes for mothers like Eva and their babies.

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