Bateman B T, Schumacher H C, Bushnell C D, Pile-Spellman J, Simpson L L, Sacco R L, Berman M F
College for Physicians & Surgeons, Columbia University, New York, NY 10032, USA.
Neurology. 2006 Aug 8;67(3):424-9. doi: 10.1212/01.wnl.0000228277.84760.a2.
To describe the frequency, risk factors, and outcome of intracerebral hemorrhage (ICH) in pregnancy and the postpartum period using a large database of US inpatient hospitalizations.
The authors obtained data from an administrative dataset, the Nationwide Inpatient Sample, which includes approximately 20% of all discharges from non-Federal hospitals, for the years 1993 through 2002. Women aged 15 to 44 years with a diagnosis of ICH were selected from the database for analysis, and within this group patients coded as pregnant or postpartum were identified. Using US Census data, estimates were made of the rates of ICH in pregnant/postpartum and non-pregnant women. Rates of various comorbidities in patients with pregnancy-related ICH were compared to the rates found in the general population of delivering patients using multivariate logistic regression to identify independent risk factors for pregnancy-related ICH.
The authors identified 423 patients with pregnancy-related ICH, which corresponded to 6.1 pregnancy-related ICH per 100,000 deliveries and 7.1 pregnancy-related ICH per 100,000 at-risk person-years (compared to 5.0 per 100,000 person-years for non-pregnant women in the age range considered). The increased risk of ICH associated with pregnancy was largely attributable to ICH occurring in the postpartum period. The in-hospital mortality rate for pregnancy-related ICH was 20.3%. ICH accounted for 7.1% of all pregnancy-related mortality recorded in this database. Significant independent risk factors for pregnancy-related ICH included advanced maternal age (OR 2.11, 95% CI 1.69 to 2.64), African American race (OR 1.83, 95% CI 1.39 to 2.41), preexisting hypertension (OR 2.61, 95% CI 1.34 to 5.07), gestational hypertension (OR 2.41, 95% CI 1.62 to 3.59), preeclampsia/eclampsia (OR 10.39, 95% CI 8.32 to 12.98), preexisting hypertension with superimposed preeclampsia/eclampsia (OR 9.23, 95% CI 5.26 to 16.19), coagulopathy (OR 20.66, 95% CI 13.67 to 31.23), and tobacco abuse (OR 1.95, 95% CI 1.11 to 3.42).
Intracerebral hemorrhage (ICH) accounts for a substantial portion of pregnancy-related mortality. The risk of ICH associated with pregnancy is greatest in the postpartum period. Advanced maternal age, African American race, hypertensive diseases, coagulopathy, and tobacco abuse were all independent risk factors for pregnancy-related ICH.
利用美国住院患者大型数据库描述妊娠及产后期间脑出血（ICH）的发生率、危险因素及转归。
作者从管理数据集全国住院患者样本中获取1993年至2002年的数据，该数据集包含约20%的非联邦医院出院病例。从数据库中选取年龄在15至44岁且诊断为ICH的女性进行分析，并在该组中识别编码为妊娠或产后的患者。利用美国人口普查数据，估算妊娠/产后女性和非妊娠女性的ICH发生率。采用多因素logistic回归比较妊娠相关ICH患者各种合并症的发生率与分娩患者总体人群中的发生率，以确定妊娠相关ICH的独立危险因素。
作者识别出423例妊娠相关ICH患者，相当于每100,000例分娩中有6.1例妊娠相关ICH，每100,000例高危人年中有7.1例妊娠相关ICH（相比之下，在所考虑年龄范围内的非妊娠女性为每100,000人年5.0例）。与妊娠相关的ICH风险增加主要归因于产后发生的ICH。妊娠相关ICH的院内死亡率为20.3%。ICH占该数据库记录的所有妊娠相关死亡的7.1%。妊娠相关ICH的重要独立危险因素包括高龄产妇（比值比[OR]2.11，95%可信区间[CI]1.69至2.64）、非裔美国人种族（OR 1.83，95%CI 1.39至2.41）、既往高血压（OR 2.61，95%CI 1.34至5.07）、妊娠期高血压（OR 2.41，95%CI 1.62至3.59）、先兆子痫/子痫（OR 10.39，95%CI 8.32至12.98）、既往高血压合并先兆子痫/子痫（OR 9.23，95%CI 5.26至16.19）、凝血病（OR 20.66，95%CI 13.67至31.23）和烟草滥用（OR 1.95，95%CI 1.11至3.42）。
脑出血（ICH）占妊娠相关死亡的很大一部分。与妊娠相关的ICH风险在产后期间最高。高龄产妇、非裔美国人种族、高血压疾病、凝血病和烟草滥用均为妊娠相关ICH的独立危险因素。
