Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada (A.Y.X.Y.).
ICES, Toronto, Ontario, Canada (A.Y.X.Y., C.D., J.F., A.C., M.K.K., J.D.E., P.C.A.).
Stroke. 2023 Feb;54(2):337-344. doi: 10.1161/STROKEAHA.122.041471. Epub 2023 Jan 23.
Pregnancy-associated stroke carries high short-term morbidity and mortality, but data on subsequent maternal outcomes are limited. We evaluated long-term maternal health outcomes after pregnancy-associated stroke.
In this retrospective cohort study, we used administrative data to identify pregnant adults aged ≤49 years with stroke between 2002-2020 in Ontario, Canada and 2 comparison groups: (1) non-pregnant female patients with stroke and (2) pregnant patients without stroke. Patients who survived the index admission were followed until 2021. After propensity score matching, we used Cox regression with a robust variance estimator to compare pregnant patients with stroke and the 2 comparison groups for the composite outcome of death and all-cause non-pregnancy readmission. Where proportional hazard assumption was not met, we reported time-varying hazard ratios (HR) with 95% CIs by modeling the log-hazard ratio as a function of time using restricted cubic splines.
We identified 217 pregnant patients with stroke, 7604 non-pregnant patients with stroke, and 1 496 256 pregnant patients without stroke. Of the 202 pregnant patients with stroke who survived the index stroke admission, 41.6% (6.8 per 100 person-years) subsequently died or were readmitted during follow-up. Median follow-up times were 5 years (pregnancy-associated stroke), 3 years (non-pregnant stroke), and 8 years (pregnant without stroke). Pregnant patients with stroke had a lower hazard of death and all-cause readmission compared with non-pregnant patients with stroke at 1-year follow-up (HR, 0.64 [95% CI, 0.44-0.94]), but this association did not persist during longer-term follow-up. Conversely, pregnant patients with stroke had higher hazard of death and readmission compared with pregnant patients without stroke at 1-year follow-up (HR, 5.70 [95% CI, 3.04-10.66]), and this association persisted for a decade.
Stroke during pregnancy is associated with long-term health consequences. It is essential to transition care postpartum to primary or specialty care to optimize vascular health.
妊娠相关卒中具有较高的短期发病率和死亡率，但关于后续母体结局的数据有限。我们评估了妊娠相关卒中后长期的母体健康结局。
在这项回顾性队列研究中，我们使用行政数据，在加拿大安大略省识别了 2002-2020 年期间年龄≤49 岁的妊娠成人卒中患者，并与 2 个对照组进行比较：（1）患有卒中的非妊娠女性患者；（2）无卒中的妊娠患者。在索引住院期间存活的患者随访至 2021 年。在进行倾向评分匹配后，我们使用具有稳健方差估计的 Cox 回归，比较妊娠卒中患者和 2 个对照组的死亡和所有原因非妊娠再入院的复合结局。当不符合比例风险假设时，我们通过使用受限立方样条函数将对数风险比建模为时间的函数来报告时间变化的风险比（HR）及其 95%置信区间。
我们确定了 217 名妊娠卒中患者、7604 名非妊娠卒中患者和 1496256 名无妊娠卒中的妊娠患者。在 202 名存活至索引卒中入院的妊娠卒中患者中，41.6%（每 100 人年 6.8 人）在随访期间死亡或再次入院。中位随访时间分别为妊娠相关卒中 5 年、非妊娠卒中 3 年和妊娠无卒中 8 年。与非妊娠卒中患者相比，妊娠卒中患者在 1 年随访时的死亡和全因再入院风险较低（HR，0.64 [95%CI，0.44-0.94]），但这种关联在长期随访中并未持续存在。相反，与妊娠无卒中患者相比，妊娠卒中患者在 1 年随访时的死亡和再入院风险较高（HR，5.70 [95%CI，3.04-10.66]），这种关联持续了 10 年。
妊娠期间发生的卒中与长期健康后果相关。产后必须将护理过渡到初级或专科护理，以优化血管健康。
