Brown David W, Dueker Nicole, Jamieson Denise J, Cole John W, Wozniak Marcella A, Stern Barney J, Giles Wayne H, Kittner Steven J
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Stroke. 2006 Apr;37(4):1055-9. doi: 10.1161/01.STR.0000206284.96739.ee. Epub 2006 Feb 16.
Preeclampsia is a pregnancy-specific systemic syndrome of unknown cause that affects 3% to 8% of pregnancies in the United States. Although preeclampsia is known to be an important risk factor for pregnancy-associated stroke, few data exist with regard to its association with stroke not occurring during pregnancy or the postpartum period.
Using data from the Stroke Prevention in Young Women Study (SPYW), a population-based case-control study of risk factors for ischemic stroke in women aged 15 to 44 years (recruitment period: 1992 to 1996, SPYW-1; 2001 to 2003, SPYW-2), we examined the independent association between a history of preeclampsia and the likelihood of ischemic stroke. Odds ratios (ORs) and 95% CIs were estimated using logistic regression. Cases (n=261) were women with stroke in the greater Baltimore-Washington area, and controls (n=421) were women free of a history of stroke identified by random digit dialing. Women who were pregnant at the time of stroke, those whose stroke occurred within 42 days postpartum, and nulligravida women were excluded from the analysis.
The prevalence of preeclampsia among cases and controls was 15% (SPYW-1: 16%; SPYW-2: 15%) and 10% (SPYW-1: 10%; SPYW-2: 11%), respectively. Preeclampsia was associated with an increased likelihood of ischemic stroke (crude OR: 1.59; 95% CI: 1.00 to 2.52). After multivariable adjustment for age, race, education, and number of pregnancies, women with a history of preeclampsia were 60% more likely to have a nonpregnancy-related ischemic stroke than those without a history of preeclampsia (OR: 1.63; 95% CI: 1.02 to 2.62). Similar patterns were observed for women who reported symptoms of preeclampsia (elevated blood pressure and proteinuria).
These results suggest an association between a history of preeclampsia and ischemic stroke remote from pregnancy. If these results are confirmed in other studies, evaluation of the importance of targeting women with preeclampsia for close risk factor monitoring and control beyond the postpartum period may be warranted.
子痫前期是一种病因不明的妊娠特异性全身性综合征，在美国3%至8%的妊娠会受其影响。尽管子痫前期是妊娠相关卒中的重要危险因素，但关于其与非孕期或产后发生的卒中之间的关联，相关数据较少。
利用年轻女性卒中预防研究（SPYW）的数据，这是一项基于人群的15至44岁女性缺血性卒中危险因素的病例对照研究（招募期：1992年至1996年，SPYW-1；2001年至2003年，SPYW-2），我们研究了子痫前期病史与缺血性卒中发生可能性之间的独立关联。采用逻辑回归估计比值比（OR）和95%置信区间（CI）。病例（n = 261）为大巴尔的摩 - 华盛顿地区的卒中女性，对照（n = 421）为通过随机数字拨号确定的无卒中病史女性。卒中时怀孕的女性、产后42天内发生卒中的女性以及未孕女性被排除在分析之外。
病例组和对照组中子痫前期的患病率分别为15%（SPYW-1：16%；SPYW-2：15%）和10%（SPYW-1：10%；SPYW-2：11%）。子痫前期与缺血性卒中发生可能性增加相关（粗OR：1.59；95% CI：1.00至2.52）。在对年龄、种族、教育程度和妊娠次数进行多变量调整后，有子痫前期病史的女性发生非妊娠相关缺血性卒中的可能性比无子痫前期病史的女性高60%（OR：1.63；95% CI：1.02至2.62）。报告有子痫前期症状（血压升高和蛋白尿）的女性也观察到类似模式。
这些结果表明子痫前期病史与妊娠后期的缺血性卒中之间存在关联。如果这些结果在其他研究中得到证实，可能有必要评估针对子痫前期女性在产后进行密切危险因素监测和控制的重要性。
