Aarnio Karoliina, Gissler Mika, Grittner Ulrike, Siegerink Bob, Kaste Markku, Tatlisumak Turgut, Tikkanen Minna, Putaala Jukka
Clinical Neurosciences, Neurology, University of Helsinki, Finland.
Department of Neurology, Helsinki University Hospital, Finland.
Eur Stroke J. 2017 Dec;2(4):346-355. doi: 10.1177/2396987317723795. Epub 2017 Jul 28.
Limited data exist on the outcome of pregnancies and deliveries in women with ischaemic stroke. We investigated the incidence of pregnancy- and delivery-related complications in women with ischaemic stroke before and after pregnancy compared with stroke-free matched controls.
Of our 1008 consecutive patients aged 15-49 years with first-ever ischaemic stroke, 1994-2007, we included women with pregnancy data before or after stroke recorded in the Medical Birth Register (MBR) ( = 152), and for them searched stroke-free controls matched by age, parity, year of birth, residential area and multiplicity ( = 608). Data on hospital admissions and deaths (1987-2014) came from national health registries. Poisson regression mixed models allowed comparison of the incidence of complications.
A total of 124 stroke mothers had 207 singleton pregnancies before and 45 mothers 68 pregnancies after stroke. The incidence rate ratio (IRR) for the composite outcome of pregnancy and delivery complications adjusted for socioeconomic status and maternal smoking was 1.43 (95% confidence interval [CI] 1.00-2.03, = 0.05) for pre-stroke mothers, and 1.09 (95% CI 0.66-1.78) for post-stroke mothers, compared with matched controls. Similarly, the adjusted IRR for post-stroke hospital admission during pregnancy was 1.85 (95% CI 1.03-3.31). The IRR for perinatal death of the child was 3.43 (95% CI 0.57-20.53) before and 8.88 (95% CI 0.81-97.95) after stroke.
Compared with stroke-free mothers, we found a higher incidence of pregnancy- and delivery-related complications in mothers with ischaemic stroke. Larger studies are needed to verify our results.
关于缺血性中风女性的妊娠和分娩结局的数据有限。我们调查了与无中风的匹配对照组相比，缺血性中风女性在妊娠前后与妊娠和分娩相关并发症的发生率。
在1994年至2007年间，我们连续纳入了1008例年龄在15至49岁之间首次发生缺血性中风的患者，其中包括在医疗出生登记册（MBR）中有中风前后妊娠数据的女性（n = 152），并为她们寻找了按年龄、产次、出生年份、居住地区和多胎情况匹配的无中风对照组（n = 608）。1987年至2014年的住院和死亡数据来自国家卫生登记处。泊松回归混合模型用于比较并发症的发生率。
共有124名中风母亲在中风前有207次单胎妊娠，45名母亲在中风后有68次妊娠。与匹配对照组相比，经社会经济地位和母亲吸烟情况调整后，中风前母亲妊娠和分娩并发症综合结局的发病率比（IRR）为1.43（95%置信区间[CI] 1.00 - 2.03，P = 0.05），中风后母亲为1.09（95% CI 0.66 - 1.78）。同样，妊娠期间中风后住院的调整后IRR为1.85（95% CI 1.03 - 3.31）。中风前儿童围产期死亡的IRR为3.43（95% CI 0.57 - 20.53），中风后为8.88（95% CI 0.81 - 97.95）。
与无中风的母亲相比，我们发现缺血性中风母亲中与妊娠和分娩相关并发症的发生率更高。需要更大规模的研究来验证我们的结果。
