From the Department of Obstetrics, Gynecology, and Reproductive Sciences (C.V.A.), Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Health Policy and Administration, Joseph L. Mailman School of Public Health (C.V.A.), Department of Neurology (M.S.V.E.), Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS), and Department of Epidemiology (M.S.V.E.), Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Department of Public Health (A.V.H., A.-M.N.A.), University of Copenhagen, Denmark; Department of Epidemiology (M.A.W., J.W.R.-E.), Harvard TH Chan School of Public Health; and Department of Medicine (J.W.R.-E.), Division of Women's Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Neurology. 2019 Sep 17;93(12):e1148-e1158. doi: 10.1212/WNL.0000000000008122. Epub 2019 Aug 16.
To test whether abruption during pregnancy is associated with long-term cerebrovascular disease by assessing the incidence and mortality from stroke among women with abruption.
We designed a population-based prospective cohort study of women who delivered in Denmark from 1978 to 2010. We used data from the National Patient Registry, Causes of Death Registry, and Danish Birth Registry to identify women with abruption, cerebrovascular events, and deaths. The outcomes included deaths resulting from stroke and nonfatal ischemic and hemorrhagic strokes. We fit Cox proportional hazards regression models for stroke outcomes, adjusting for the delivery year, parity, education, and smoking.
The median (interquartile range) follow-up in the nonabruption and abruption groups was 15.9 (7.8-23.8) and 16.2 (9.6-23.1) years, respectively, among 828,289 women with 13,231,559 person-years of follow-up. Cerebrovascular mortality rates were 0.8 and 0.5 per 10,000 person-years among women with and without abruption, respectively (hazard ratio [HR] 1.6, 95% confidence interval [CI] 0.9-3.0). Abruption was associated with increased rates of nonfatal ischemic stroke (HR 1.4, 95% CI 1.1-1.7) and hemorrhagic stroke (HR 1.4, 95% CI 1.1-1.9). The association of abruption and stroke was increased with delivery at <34 weeks, when accompanied by ischemic placental disease, and among women with ≥2 abruptions. These associations are less likely to have been affected by unmeasured confounding.
Abruption is associated with increased risk of cerebrovascular morbidity and mortality. Disruption of the hemostatic system manifesting as ischemia and hemorrhage may indicate shared etiologies between abruption and cerebrovascular complications.
通过评估胎盘早剥孕妇的中风发病率和死亡率，检验妊娠期间胎盘早剥是否与长期脑血管疾病相关。
我们设计了一项基于人群的前瞻性队列研究，研究对象为 1978 年至 2010 年在丹麦分娩的女性。我们利用国家患者登记处、死因登记处和丹麦出生登记处的数据来识别胎盘早剥、脑血管事件和死亡的女性。结果包括中风导致的死亡和非致命性缺血性和出血性中风。我们使用 Cox 比例风险回归模型来调整分娩年份、产次、教育程度和吸烟状况后，分析中风结果。
在 828289 名女性中，非胎盘早剥组和胎盘早剥组的中位（四分位距）随访时间分别为 15.9（7.8-23.8）和 16.2（9.6-23.1）年，随访 13231559 人年。胎盘早剥组和非胎盘早剥组的脑血管死亡率分别为 0.8 和 0.5/10000 人年（危险比[HR] 1.6，95%置信区间[CI] 0.9-3.0）。胎盘早剥与非致命性缺血性中风（HR 1.4，95% CI 1.1-1.7）和出血性中风（HR 1.4，95% CI 1.1-1.9）的发生率增加相关。当胎盘早剥发生于＜34 周、同时伴有缺血性胎盘疾病或孕妇发生≥2 次胎盘早剥时，胎盘早剥与中风的相关性增加。这些关联不太可能受到未测量的混杂因素的影响。
胎盘早剥与脑血管发病率和死亡率增加相关。止血系统的破坏表现为缺血和出血，可能表明胎盘早剥和脑血管并发症之间存在共同的病因。
