Researchers utilize matched cohorts to comparatively assess potential risk factors associated with brain stroke during pregnancy
Acute stroke occurs when the flow of blood to the brain is disrupted, resulting in damage to brain cells
. However, the occurrence of acute stroke during pregnancy and puerperium-the time following childbirth-can be life-threatening. Recent studies indicate that the incidence of acute stroke in pregnancy and puerperium (ASPP) is increasing accompanied by an in-hospital death rate of 4.2%. Owing to the higher risk of severe disease and challenges in the clinical management of pregnant women with acute stroke, there is an urgent need for studies investigating the potential risk factors of ASPP and risk of recurrent strokes during future pregnancies.
Against this backdrop, a team of researchers from China has conducted a retrospective, nationwide, multicenter study to advance current knowledge and understanding about ASPP. The team was led by Dr. Jizong Zhao from the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China comparatively analysed patients with ASPP and non-ASPP participants between January 2015 to November 2024. Laying the groundwork for their research, the research team has developed a comprehensive study protocol. Their study protocol was recently published online in the
Chinese Neurosurgical Journal on June 04, 2025.
Sharing insights on the need for the present study, Dr. Zhao says,
“Previous studies have predominantly utilized large-scale national healthcare data and the International Classification of Diseases (ICD) parameters to assess the incidence rate and risk factors associated with ASPP. Although these population-based studies benefit from larger sample sizes, they often lack detailed data, which prevents the comprehensive exploration of risk factors and the identification of prognostic predictors”.
In their study, the researchers aimed to address three critical aspects related to ASPP: (1) to identify risk factors of ASPP and predictors of its prognosis, (2) to evaluate the risk of recurrent strokes, particularly during subsequent pregnancies in ASPP patients, and (3) to assess the prognosis of offspring of ASPP patients. Furthermore, to enable the present research to be classified as a national-level study, they included 36 tertiary hospitals from 22 provinces of China which had higher incidence rate of ASPP cases along with certification to provide standardized stroke care.
The study involved the use of two matched control groups for comparison: 400 pregnant or puerperal participants with no history of stroke and 400 non-pregnant participants who recently experienced a stroke. Baseline variables to be assessed ranged from demographics, medical history, medication history, to pregnancy or puerperium-related data. While electronic medical record (EMR) system was employed to collect baseline clinical data, telephonic interviews were used to follow up the study participants. Moreover, the follow up schedule was designed to include up to three rounds, with the third and final follow-up to be conducted between December 2030 and February 2031.
To effectively assess the short-term and long-term study outcomes in women, the team utilized disability rating scales and quality of life related questionnaires. Additionally, APGAR scores (appearance, pulse, grimace, activity, respiration) and Ages and Stages Questionnaire
(3
rd edition) was employed to evaluate the impact of ASPP on newborns.
“To begin with, this study does not rely on the ICD-based coding and can thus avoid coding errors, such as misclassification and underreporting. Next, it is capable of collecting long-term recovery outcomes for patients with ASPP. Furthermore, it will be the first study to explore whether ASPP affects the development of offspring,” states Dr. Zhao, elaborating on the strengths and novelty of the present research,
This extensive research protocol sets the stage for identifying key risk factors associated with ASPP and offers valuable insights into its long-term implications for both mothers and their children. It represents a significant step toward improving clinical understanding and management of pregnancy-related stroke.
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Reference
Titles of original paper: Clinical characteristics and prognosis of acute stroke in pregnancy and puerperium (ASPP) patients and their offspring: a retrospective, observational, nationwide, multicenter study protocol
Journal:
Chinese Neurosurgical Journal
DOI:
10.1186/s41016-025-00396-5