Miller Eliza C, Gatollari Hajere J, Too Gloria, Boehme Amelia K, Leffert Lisa, Marshall Randolph S, Elkind Mitchell S V, Willey Joshua Z
From the Department of Neurology, College of Physicians and Surgeons (E.C.M., A.K.B., R.S.M., M.S.V.E., J.Z.W.), Department of Epidemiology, Mailman School of Public Health (H.J.G., A.K.B., M.S.V.E.), and Department of Obstetrics and Gynecology (G.T.), Columbia University, New York, NY; and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston (L.L.).
Stroke. 2017 Jul;48(7):1752-1759. doi: 10.1161/STROKEAHA.117.017374. Epub 2017 May 25.
Preeclampsia affects 3% to 8% of pregnancies and increases risk of pregnancy-associated stroke (PAS). Data are limited on which women with preeclampsia are at highest risk for PAS.
Using billing data from the 2003 to 2012 New York State Department of Health inpatient database, we matched women with preeclampsia and PAS 1:3 to preeclamptic controls based on age and race/ethnicity. Pre-defined PAS risk factors included pregnancy complications, infection present on admission, vascular risk factors, prothrombotic states, and coagulopathies. We constructed multivariable conditional logistic regression models to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for independent risk factors for PAS.
Among women aged 12 to 55 years admitted to New York State hospitals for any reason during the study period (n=3 373 114), 88 857 had preeclampsia, and 197 of whom (0.2%) had PAS. In multivariable analysis, women with preeclampsia and stroke were more likely than controls to have severe preeclampsia or eclampsia (OR, 7.2; 95% confidence interval [CI], 4.6-11.3), infections present on admission (OR, 3.0; 95% CI, 1.6-5.8), prothrombotic states (OR, 3.5; 95% CI, 1.3-9.2), coagulopathies (OR, 3.1; 95% CI, 1.3-7.1), or chronic hypertension (OR, 3.2; 95% CI, 1.8-5.5). Additional analyses matched and stratified by severity of preeclampsia confirmed these results.
Infections, chronic hypertension, coagulopathies, and underlying prothrombotic conditions increase PAS risk in women with preeclampsia. These women may warrant closer monitoring.
子痫前期影响3%至8%的妊娠，并增加妊娠相关卒中（PAS）的风险。关于哪些子痫前期女性发生PAS的风险最高，数据有限。
利用2003年至2012年纽约州卫生部住院患者数据库中的计费数据，我们根据年龄和种族/民族，将子痫前期合并PAS的女性与子痫前期对照按1:3进行匹配。预先定义的PAS危险因素包括妊娠并发症、入院时存在的感染、血管危险因素、血栓前状态和凝血障碍。我们构建了多变量条件逻辑回归模型，以计算PAS独立危险因素的比值比（OR）和95%置信区间（95%CI）。
在研究期间因任何原因入住纽约州医院的12至55岁女性（n = 3373114）中，88857例患有子痫前期，其中197例（0.2%）发生PAS。在多变量分析中，子痫前期合并卒中的女性比对照组更有可能患有重度子痫前期或子痫（OR，7.2；95%置信区间[CI]，4.6 - 11.3）、入院时存在感染（OR，3.0；95%CI，1.6 - 5.8）、血栓前状态（OR，3.5；95%CI，1.3 - 9.2）、凝血障碍（OR，3.1；95%CI，1.3 - 7.1）或慢性高血压（OR，3.2；95%CI，1.8 - 5.5）。按子痫前期严重程度进行匹配和分层的额外分析证实了这些结果。
感染、慢性高血压、凝血障碍和潜在的血栓前状态会增加子痫前期女性发生PAS的风险。这些女性可能需要更密切的监测。
