Trager Robert J, Daniels Clinton J, Scott Zachary E, Perez Jaime A
Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland OH, USA.
Rehabilitation Care Services, VA Puget Sound Health Care System, 9600 Veterans Drive, Tacoma, WA, 98493, USA.
J Stroke Cerebrovasc Dis. 2023 Nov;32(11):107384. doi: 10.1016/j.jstrokecerebrovasdis.2023.107384. Epub 2023 Sep 22.
We hypothesized that pregnant women would have an increased risk of spontaneous cervical artery dissection (sCeAD) affecting the carotid or vertebral arteries over one-year follow-up after the first trimester ultrasound compared to matched non-pregnant controls.
We queried a United States research network (TriNetX, Inc.) of de-identified medical records of >111 million patients, with data spanning 2008-2023. We included women aged ≥18 and excluded those with trauma and conditions potentially causative of sCeAD. Women were divided into cohorts based on a first trimester ultrasound and subsequent labor, delivery, or full-term pregnancy, or gynecological examination and no pregnancy. We used propensity matching to control for variables associated with sCeAD and calculated the risk ratio (RR) of sCeAD occurring over one-year follow-up from the index date of ultrasound or gynecological exam.
After matching, the incidence rate of sCeAD in the pregnancy cohort was 8.0 (95% CI: 8.0-8.1) per 100,000 person-years, compared to 3.9 (95% CI: 3.9-3.9) per 100,000 person-years in the non-pregnancy cohort, yielding an RR (95% CI) of 2.06 (1.17-3.61; P= .0104). A cumulative incidence graph suggested that most cases of sCeAD in the pregnancy cohort occurred during pregnancy rather than the postpartum period.
Our findings demonstrate that women have a twofold increased risk of sCeAD during pregnancy and the postpartum period compared to non-pregnant women. Further research is needed to determine whether maternal comorbidities such as preeclampsia account for these findings, and clarify when sCeAD occurs in relation to pregnancy or the postpartum period.
我们假设，与匹配的非孕妇对照组相比，在孕早期超声检查后的一年随访中，孕妇发生影响颈动脉或椎动脉的自发性颈内动脉夹层（sCeAD）的风险会增加。
我们查询了美国一个研究网络（TriNetX公司）中超过1.11亿患者的去识别化医疗记录，数据涵盖2００８年至2０23年。我们纳入了年龄≥18岁的女性，并排除了有创伤以及可能导致sCeAD的疾病的女性。根据孕早期超声检查及随后的分娩、足月妊娠或妇科检查且未怀孕情况，将女性分为不同队列。我们使用倾向匹配法来控制与sCeAD相关的变量，并计算从超声检查或妇科检查的索引日期起一年随访中发生sCeAD的风险比（RR）。
匹配后，妊娠队列中sCeAD的发病率为每10万人年8.0（95%CI：8.0 - 8.1），而非妊娠队列中为每10万人年3.9（95%CI：3.9 - 3.9），RR（95%CI）为2.06（1.17 - 3.61；P = 0.0104）。累积发病率图表明，妊娠队列中大多数sCeAD病例发生在孕期而非产后。
我们的研究结果表明，与非孕妇相比，女性在孕期和产后发生sCeAD的风险增加了两倍。需要进一步研究以确定诸如先兆子痫等母体合并症是否能解释这些结果，并阐明sCeAD在何时与妊娠或产后相关发生。
