Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Eur Stroke J. 2023 Jun;8(2):475-482. doi: 10.1177/23969873231170096. Epub 2023 Apr 24.
Ischemic stroke (IS) is an uncommon, but potentially life-changing, complication of pregnancy. The aim of this study was to analyze the etiology and risk factors of pregnancy-associated IS.
We collected a population-based retrospective cohort of patients diagnosed with IS during pregnancy or puerperium in Finland from 1987 to 2016. These women were identified by linking the Medical Birth Register (MBR) with the Hospital Discharge Register. Three matched controls were selected from MBR for each case. The diagnosis and temporal relationship of IS to pregnancy, and clinical details were verified from patient records.
A total of 97 women (median age 30.7 years) were identified as having pregnancy-associated IS. The most common etiologies based on TOAST classification were cardioembolism in 13 (13.4%), other determined in 27 (27.8%) and undetermined in 55 (56.7%) patients. Fifteen patients (15.5%) had embolic strokes of undetermined sources. The most important risk factors were pre-eclampsia, eclampsia, gestational hypertension, and migraine. IS patients had more frequently traditional and pregnancy-related stroke risk factors than the controls (OR 2.38, 95% CI 1.48-3.84) and the risk of IS multiplied with the number of risk factors (4-5 risk factors: OR 14.21, 95% CI 1.12-180.48).
Rare causes and cardioembolism were frequent etiologies for pregnancy-associated IS, but in half of the women, the etiology remained undetermined. The risk of IS increased with the number of risk factors. Surveillance and counseling of pregnant women, especially with multiple risk factors, is crucial for the prevention of pregnancy-associated IS.
缺血性脑卒中（IS）是妊娠的罕见但潜在改变生活的并发症。本研究旨在分析妊娠相关 IS 的病因和危险因素。
我们收集了芬兰从 1987 年到 2016 年期间在妊娠或产褥期被诊断为 IS 的基于人群的回顾性队列患者。这些女性通过将医疗出生登记（MBR）与住院记录相链接来确定。为每个病例选择了 3 个来自 MBR 的匹配对照。从患者记录中验证了 IS 与妊娠的诊断和时间关系以及临床细节。
共确定了 97 名（中位年龄 30.7 岁）患有妊娠相关 IS 的女性。根据 TOAST 分类，最常见的病因是心源性栓塞 13 例（13.4%）、其他确定病因 27 例（27.8%）和未确定病因 55 例（56.7%）。15 例（15.5%）患者有不明来源的栓塞性脑卒中。最重要的危险因素是子痫前期、子痫、妊娠高血压和偏头痛。与对照组相比，IS 患者更频繁地具有传统和妊娠相关的卒中危险因素（OR 2.38，95%CI 1.48-3.84），且随着危险因素数量的增加，IS 的风险也随之增加（4-5 个危险因素：OR 14.21，95%CI 1.12-180.48）。
妊娠相关 IS 的罕见病因和心源性栓塞较为常见，但在一半的女性中，病因仍未确定。IS 的风险随着危险因素数量的增加而增加。对孕妇，特别是有多个危险因素的孕妇进行监测和咨询对于预防妊娠相关 IS 至关重要。
