From the French Public Health Agency (A.M., G.L., A.G., C.G., N.R., E.C., E.M., V.O.), Saint-Maurice; Dijon Stroke Registry (Y.B.), University Hospital and Medical School of Dijon, University of Burgundy; Inserm U1153 (C.D.-T., G.P.-B.), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS); Paris-Descartes University (C.D.-T., V.T., G.P.-B., J.B.); Diagnosis and Therapeutic Center (S.K., J.B.), Hotel Dieu, AP-HP, University Paris Descartes; Vascular Medecine and Hypertension Center (C.M.-V.), EA 2694, Santé Publique, University Lille; Department of Obstetrics and Gynecology (V.T.), APHP, Port-Royal Maternity, University Hospital Center Cochin Broca Hôtel Dieu, Groupe Hospitalier Universitaire Ouest; and Division of Gynaecology (G.P.-B.), APHP, Hôpital Cochin, Paris, France.
Neurology. 2022 Oct 11;99(15):e1598-e1608. doi: 10.1212/WNL.0000000000200944. Epub 2022 Aug 29.
Despite the potentially devastating effects of pregnancy-related stroke, few studies have examined its incidence by type of stroke. We aimed to study the nationwide incidence rates and recent temporal trends for all types of pregnancy-related stroke and to compare these incidences with stroke incidence in nonpregnant women.
We conducted a study of 6,297,698 women aged 15-49 years who gave birth in France between 2010 and 2018 with no history of stroke before pregnancy by collecting data from the French National Health Insurance Information System database. Poisson regression was used to estimate the incidence by types of strokes for the different pregnancy periods and the incidence rate ratio of stroke in pregnant vs nonpregnant French women.
Among the 6,297,698 women, 1,261 (24.0 per 100,000 person-years) experienced a first ever stroke during, antepartum peripartum, or the first 6 weeks of postpartum. Of the pregnancy-related strokes, 42.9% were ischemic (IS), 41.9% were hemorrhagic (with similar proportion of intracerebral and subarachnoid hemorrhage), and 17.4% were cerebral venous thrombosis (CVT). Compared with nonpregnant women, incidence rates of stroke were similar during pregnancy for IS (adjusted incidence risk ratio [IRR] 0.9 [0.8-1.1]), slightly higher for all hemorrhagic strokes (IRR 1.4 [1.2-1.8]), and considerably increased for CVT (IRR 8.1 [6.5-10.1]). Pregnancy-related stroke incidence rose between 2010 and 2018 for IS and HS but was stable for CVT.
The risk of pregnancy-related CVT was more than 8-fold higher than that observed in nonpregnant women. The incidence of pregnancy-related IS and HS is increasing over time, and efforts should be made for prevention considering treatable cardiovascular risk factors and hypertensive disorders in pregnant women.
尽管妊娠相关卒中可能产生毁灭性影响，但鲜有研究分析过不同卒中类型的发病率。我们旨在研究法国全国范围内所有妊娠相关卒中的发病率及近期时间趋势，并与非妊娠女性的卒中发病率进行比较。
我们通过法国国家健康保险信息系统数据库收集了 2010 年至 2018 年期间无妊娠前卒中史的 6,297,698 名 15-49 岁分娩女性的数据，开展了一项研究。我们采用泊松回归估计了不同妊娠期间不同类型卒中的发病率，并比较了妊娠和非妊娠法国女性的卒中发病率比。
在 6,297,698 名女性中，1,261 名（24.0/100,000 人年）在围产期或产后 6 周内首次发生卒中。妊娠相关卒中中，42.9%为缺血性卒中（IS），41.9%为出血性卒中（其中颅内出血和蛛网膜下腔出血比例相似），17.4%为脑静脉血栓形成（CVT）。与非妊娠女性相比，IS 的妊娠期间卒中发病率相似（校正发病率风险比[IRR]0.9 [0.8-1.1]），所有出血性卒中的发病率略高（IRR 1.4 [1.2-1.8]），而 CVT 的发病率则明显增加（IRR 8.1 [6.5-10.1]）。2010 年至 2018 年，IS 和 HS 的妊娠相关卒中发病率上升，但 CVT 则保持稳定。
妊娠相关 CVT 的风险比非妊娠女性高 8 倍以上。妊娠相关 IS 和 HS 的发病率随时间推移而增加，应针对可治疗的心血管危险因素和妊娠高血压疾病采取预防措施。
