| Experts: Risk of Stroke
May Start in the Womb
have long struggled to explain why some people living in certain
regions of the U.S. and UK are more likely to develop stroke than
Now, two experts are looking to
the womb to explain this uneven pattern. They found that UK regions
marked by high stroke rates also showed high rates of death among
mothers and infants in the early 20th century, the years when
many stroke patients were born.
This trend suggests that the mysterious
variations in stroke rates may be the result of historical, regional
differences in maternal health, they write in a report released
If this theory proves correct,
study author Dr. David J. P. Barker of the University of Southampton
in the UK told Reuters Health that, in the next generation, stroke
prevention may lie "in good nutrition among mothers at conception
In the U.S., the southeast is known
as the "stroke belt," a region where stroke rates and the risk
of death from stroke are significantly higher than in the rest
of the country.
In England and Wales, researchers
have found that stroke rates tend to spike in northern towns,
where they are accompanied by similar increases in the rates of
high blood pressure and death from heart disease.
Researchers who have investigated
the potential reasons behind the patchwork distribution of stroke
rates in the U.S. have shown they bear no relationship to inequalities
in medical care, and have uncovered no explanation for why they
Now, in the journal Stroke: Journal
of the American Heart Association, Barker and co-author Dr. Daniel
T. Lackland of the Medical University of South Carolina in Charleston
propose that the differences in stroke rates may stem from previous
geographical variations in overall prenatal health.
In the report, Barker and Lackland
compare stroke-related death rates in different regions of England
and Wales between 1968 and 1978 to the rate of maternal and infant
deaths during the first part of the 20th century, approximately
the time when many stroke patients were born.
In an interview, Barker said that
places in the UK that are characterized by high rates of stroke
had historically high rates of death among mothers and babies.
"It's a very strong relationship," he explained.
As further evidence that the risk
of stroke may begin before birth, Barker said that people with
low birth weights -- a sign of poor prenatal nutrition -- are
more likely to eventually develop stroke.
He added that the phenomenon of
the U.S. stroke belt and other regions with high stroke rates
applies to people who were born in these areas, and not those
who moved there later in life. "The place where you're born is
a strong determinant of your stroke risk," he said.
In an accompanying editorial, Dr.
Larry B. Goldstein of Duke University in Durham, North Carolina
cautions that the current report only links stroke risk to in
utero health, and does not show that one causes the other.
"Despite this inherent limitation
... the data provide another compelling argument to ensure adequate
prenatal care and maternal nutrition," Goldstein writes.
SOURCE: Stroke 2003;10.1161/01.STR.0000077257.27430.7E
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