Swartz Richard H, Cayley Megan L, Foley Norine, Ladhani Noor Niyar N, Leffert Lisa, Bushnell Cheryl, McClure J A, Lindsay M Patrice
1 Department of Medicine (Neurology) and the Hurvitz Brain Sciences Research Program, Sunnybrook HSC, Toronto, Canada.
2 University of Toronto, Toronto, Canada.
Int J Stroke. 2017 Oct;12(7):687-697. doi: 10.1177/1747493017723271.
Background Stroke risk is increased during pregnancy, but estimates of pregnancy-related stroke incidence vary widely. Aims A systematic review and meta-analysis was conducted to assess the incidence of stroke during pregnancy and the puerperium. Ovid Medline, EMBASE, and ISI Web of Science were searched for studies published between 1990 and January 2017 reporting stroke incidence during pregnancy and postpartum, from defined pregnancy populations. Pooled analyses were conducted using a random effects approach and expressed as an incidence rate per 100,000 pregnancies, with 95% confidence intervals. Subgroup analyses of stroke type and timing were conducted. Summary of review Eleven studies met inclusion criteria. Variation in estimated rates was noted based on geography and study methodology. The pooled crude rate of pregnancy-related stroke was 30.0 per 100,000 pregnancies (95% confidence interval 18.8-47.9). The pooled crude rates from nonhemorrhagic stroke (arterial and cerebral venous sinus thrombosis) were 19.9 (95% confidence interval 10.7-36.9) and from hemorrhage 12.2 (95% confidence interval 6.4-23.2) per 100,000 pregnancies. For studies separately reporting cerebral venous sinus thrombosis, the rates were roughly equal between ischemic stroke (12.2, 95% confidence interval 6.7-22.2), cerebral venous sinus thrombosis (9.1, 95% confidence interval 4.3-18.9), and hemorrhage (12.2, 95% confidence interval 6.4-23.2). The crude stroke rate for antenatal/perinatal stroke was 18.3 (95% confidence interval 11.9-28.2), and for postpartum stroke was 14.7 (95% confidence interval 8.3-26.1). Conclusions Stroke affects 30.0 per 100,000 pregnancies, with ischemia, cerebral venous sinus thrombosis, and hemorrhage causing roughly equal numbers and with highest risk peripartum and postpartum. Organized approaches to the management of this high-risk population, informed by existing evidence from stroke and obstetrical care are needed.
孕期中风风险会增加，但与妊娠相关的中风发病率估计差异很大。目的：进行一项系统评价和荟萃分析，以评估孕期和产褥期中风的发病率。检索了Ovid Medline、EMBASE和ISI Web of Science，查找1990年至2017年1月期间发表的、报告特定妊娠人群孕期和产后中风发病率的研究。采用随机效应方法进行汇总分析，并以每10万次妊娠的发病率表示，同时给出95%置信区间。对中风类型和发病时间进行了亚组分析。综述总结：11项研究符合纳入标准。根据地理位置和研究方法，估计发病率存在差异。与妊娠相关的中风汇总粗发病率为每10万次妊娠30.0例（95%置信区间18.8 - 47.9）。非出血性中风（动脉和脑静脉窦血栓形成）的汇总粗发病率为每10万次妊娠19.9例（95%置信区间10.7 - 36.9），出血性中风为每10万次妊娠12.2例（95%置信区间6.4 - 23.2）。对于分别报告脑静脉窦血栓形成的研究，缺血性中风（12.2，95%置信区间6.7 - 22.2）、脑静脉窦血栓形成（9.1，95%置信区间4.3 - 18.9）和出血（12.2，95%置信区间6.4 - 23.2）的发病率大致相等。产前/围产期中风的粗发病率为18.3（95%置信区间11.9 - 28.2），产后中风为14.7（95%置信区间8.3 - 26.1）。结论：中风影响每10万次妊娠中的30.0例，缺血、脑静脉窦血栓形成和出血导致的病例数大致相等，且围产期和产后风险最高。需要根据中风和产科护理的现有证据，制定针对这一高危人群的有组织管理方法。
