National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
Obstet Gynecol. 2012 Aug;120(2 Pt 1):318-24. doi: 10.1097/AOG.0b013e31825f287c.
To estimate the incidence of antenatal stroke in the United Kingdom and to describe risk factors associated with stroke during pregnancy, management, and outcomes.
A population-based (nationwide) cohort and nested case-control study was conducted using the UK Obstetric Surveillance System between October 2007 and March 2010. We investigated the potential factors associated with antenatal stroke using a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Thirty cases of antenatal stroke were reported giving an estimated incidence of 1.5 cases per 100,000 women delivering (95% CI 1.0-2.1). The incidences of nonhemorrhagic and hemorrhagic stroke were 0.9 (95% CI 0.5-1.3) and 0.6 (95% CI 0.3-1.0) per 100,000 women delivering. Factors associated with increased risk of antenatal stroke were history of migraine (adjusted OR 8.5, 95% CI 1.5-62.1), gestational diabetes (adjusted OR 26.8, 95% CI 3.2-∞), and preeclampsia or eclampsia (adjusted OR 7.7, 95% CI 1.3-55.7). There was wide variation in the use of pharmacologic, surgical, and organized stroke unit care. There were six stroke-related maternal deaths giving a case-fatality rate of 20% of all strokes, 50% of hemorrhagic strokes, and a mortality rate of 0.3 (95% CI 0.1-0.6) per 100,000 women delivering.
The risk of a stroke during pregnancy is low; however, the poor outcomes in terms of morbidity and mortality and variations in care highlight the importance of such women receiving specialist stroke care. Clinicians should be aware of an association with a history of migraine, gestational diabetes, and preeclampsia or eclampsia.
II.
估计英国产前中风的发病率，并描述与妊娠期间中风相关的风险因素、管理和结局。
本研究采用基于人群（全国性）的队列和嵌套病例对照研究，使用英国产科监测系统（UK Obstetric Surveillance System）于 2007 年 10 月至 2010 年 3 月期间进行调查。我们使用逻辑回归分析来研究与产前中风相关的潜在因素，以估计比值比（ORs）和 95%置信区间（CIs）。
报告了 30 例产前中风病例，估计每 100,000 名分娩妇女中有 1.5 例（95%CI 1.0-2.1）。非出血性和出血性中风的发病率分别为每 100,000 名分娩妇女 0.9（95%CI 0.5-1.3）和 0.6（95%CI 0.3-1.0）。与产前中风风险增加相关的因素包括偏头痛史（调整后的 OR 8.5，95%CI 1.5-62.1）、妊娠糖尿病（调整后的 OR 26.8，95%CI 3.2-∞）和子痫前期或子痫（调整后的 OR 7.7，95%CI 1.3-55.7）。在药物治疗、手术和组织化卒中单元治疗的应用方面存在广泛的差异。有 6 例与中风相关的产妇死亡，导致所有中风的病死率为 20%，出血性中风的病死率为 50%，每 100,000 名分娩妇女的死亡率为 0.3（95%CI 0.1-0.6）。
妊娠期间中风的风险较低；然而，发病率和死亡率的不良结局以及护理方面的差异突出表明，此类妇女需要接受专科卒中护理。临床医生应该意识到与偏头痛史、妊娠糖尿病和子痫前期或子痫相关的关联。
II 级。
