At age 25, home with a week-old baby boy, Rachel Eagly had no reason to think a little headache meant she was having a stroke.
But then came the blinding pain, the starburst flashes of light, the slurred speech and sudden weakness in her right arm.
Within hours, emergency doctors confirmed what no one wanted to believe: A blood vessel had burst in Eagly’s brain.
“I remember thinking something’s wrong here and I don’t know what it is,” recalled Eagly, now 30, who was placed in a medically induced coma for nearly two weeks, and then hospitalized for months while she relearned how to speak and walk, even as she cared for her newborn son, Aidan.
Just-released research from a large national study shows that the Lansing, Mich., mom is part of a frightening trend: Rates of stroke in women during pregnancy or soon after giving birth have jumped 54 percent in a dozen years.
Spurred largely by an increase in cases of high blood pressure and heart disease, the number of pregnancy-related stroke hospitalizations climbed by more than 2,200 between 1994-95 and 2006-2007 — the year Aidan was born — according to a new study published in the journal Stroke.
That’s a troubling rise, even for a condition that remains rare, said Dr. Elena V. Kuklina, the study’s lead author, stroke expert and epidemiologist at the federal Centers for Disease Control and Prevention. Overall, strokes were detected in about 71 of every 100,000 delivery hospitalizations by the end of the study period.
“We expected some degree of increase, but I was surprised to find such magnitude,” said Kuklina, who analyzed records from the Nationwide Inpatient Sample, a database that includes from five million to eight million discharge records from 1,000 hospitals.
The rate of stroke climbed about 47 percent in women before giving birth and about 83 percent in new moms in the postpartum period, 12 weeks after giving birth. The risk of stroke rises in pregnancy in part because of a higher volume of blood, but also because of increased risk of high blood pressure, blood clots and migraine headaches. Dramatic fluctuations in hormones and blood pressure in the weeks after giving birth may increase risk during that time, doctors say.
High blood pressure, heart disease to blame
Almost all of the increase in strokes during or soon after pregnancy was explained by higher prevalence of high blood pressure and heart disease during pregnancy, said Kuklina. That’s a worrisome trend in a nation where roughly one in five women is obese when she becomes pregnant, a risk factor for both conditions.
“We are dealing with a different population of pregnant women now,” said Kuklina, who urged better preventive care and monitoring by doctors and pregnant patients.
Pregnant women and new mothers ages 25 to 34 were hospitalized for stroke more often than women who were younger or older, the study found.
Kuklina's study offers a large-scale look at a pressing problem, said Dr. Steven Kittner, a professor of neurology at the University of Maryland and staff physician at the Baltimore Veterans Affairs Medical Center.
"From a point of view of public health, it's important to be aware of this and investigate it further," he said.
Eagly, who fell squarely into the group covered by the last year of the study, didn’t have high blood pressure or heart disease, although she did gain about 50 pounds during her pregnancy, about 15 pounds more than the highest recommended amount. She said doctors told her that the fluctuations in hormones after she gave birth might have contributed to her hemorrhagic stroke, but they offered no clear cause.
What was clear was how the stroke affected her life. Eagly doesn’t remember most of the first month of Aidan’s life because she was placed in the medical coma that aimed to reduce swelling on her brain. Eagly’s mother, Gail Bratt, of Three Rivers, Mich., shocked and worried herself at her daughter’s plight, took over care of the baby, even making sure he cuddled with his mom.
“We put the baby right on her while she was in the coma,” Bratt recalled. “It was horrible, but we wanted the baby to bond."
Eagly, who was formerly right-handed, had to learn to do everything left-handed, even change her newborn's diapers, after the stroke left her unable to use her right arm. She still wears a brace on her right leg and suffers from aphasia, a disorder that impairs the understanding and expression of language. During the emotional ordeal of recalling her stroke, Eagly frequently relied on her mom to help find the right words.
Now 30, Eagly wasn’t able to return to her job as a social worker helping people with mental illness. Aidan's dad left the relationship four months after Eagly's stroke, though she says they're cordial now. As a disabled single parent, Eagly admits it can be hard to keep up with a lively 5-year-old who will start kindergarten in the fall.
“Recently, you know, he called me a slowpoke because I can’t walk fast,” Egly said.
But the young mom who says “I hate the word can’t,” is determined to be independent despite the stroke. Three years ago, Eagly moved into a three-bedroom Habitat for Humanity home that she helped build.
Marriage, children's book on the horizon
Working with the National Aphasia Association, she has written a book to help explain stroke to children. Called “Mama, Just Shake It,” the book title refers to Aidan’s plea that his mom make her arm work by shaking it to turn it on.
“He know that mom had a stroke and that it’s caused by the brain,” she said. “That satisfied his curiosity for a while.”
The aphasia association is the same group that introduced Egly to her fiancé, Brian Gay, 27, who suffered the same kind of stroke at age 16 on a football field. Until she suffered a stroke herself, Egly didn’t know that young people could be affected, too.
“I didn’t know what a stroke was. I thought old people had strokes, nothing that I needed to worry about,” said Eagly. “If would have known the symptoms, I would have gone to the ER way earlier than I did."