Fischer Sandro K, Kaufmann Josefin E, Metso Tiina M, Tatlisumak Turgut, Wischmann Johannes, Kellert Lars, Mayer-Suess Lukas, Knoflach Michael, von Rennenberg Regina, Nolte Christian H, Lee Cheyenne, Aldridge Chad M, Worrall Bradford B, Weko Andrew T, Southerland Andrew M, Wiggins Judea P, Majersik Jennifer J, Baumgartner Philipp, Wegener Susanne, Metanis Issa, Leker Ronen R, Cano-Nigenda Vanessa, Arauz Antonio, Frances Anabella, Bozas Ignacio, Martin Juan J, Zietz Annaelle, Polymeris Alexandros, Altersberger Valerian L, Abrignani Giorgia, Castellini Paola, Genovese Antonio, Latte Lilia, Trapasso Maria Claudia, Zedde Marialuisa, Bersano Anna, Marinoni Giulia, Silvestrelli Giorgio, Baracchini Claudio, Favruzzo Francesco, Paciaroni Maurizio, Spalloni Alessandra, Patella Rosalba, Cappellari Manuel, Valletta Francesco, Del Sette Massimo, Sassos Davide, Gentile Mauro, Magoni Mauro, Gamba Massimo, Padroni Marina, Azzini Cristiano, Giorli Elisa, Melis Fabio, Tassi Rossana, Calabrò Rocco Salvatore, Piras Valeria, Melis Maurizio, Giossi Alessia, Sanguigni Sandro, Mannino Marina, Bignamini Valeria, Gaiani Alessandra, Adami Alessandro, Bella Rita, Pascarella Rosario, Lyrer Philippe, Gensicke Henrik, Pezzini Alessandro, Traenka Christopher, Engelter Stefan T
Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland.
Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
JAMA Netw Open. 2025 Jul 1;8(7):e2521539. doi: 10.1001/jamanetworkopen.2025.21539.
Cervical artery dissection (CeAD) is a leading cause of stroke in young people and can occur during pregnancy. In women with prior CeAD, it is unclear whether future pregnancies increase the risk of recurrent CeAD, stroke, or death.
To compare the frequency of recurrent CeAD, stroke, or death as a composite outcome between patients with CeAD who became pregnant vs those who did not.
DESIGN, SETTING, AND PARTICIPANTS: The Long-Term Risk of Recurrent Cervical Artery Dissection and Stroke After Pregnancy (LONG-RECAP) study was an international, multicenter, registry-based, explorative cohort study with data from May 1, 1990, and April 30, 2023, among patients with CeAD at 33 stroke centers across 9 countries who had at least 6 months of follow-up for whom detailed information was available on absence vs presence of subsequent pregnancies and the occurrence of outcome events.
Pregnancy after CeAD.
Composite of recurrent CeAD, stroke (any type), and death (all causes) during follow-up at least 6 months after initial CeAD. Secondary outcomes were the components of the composite outcome. Cox proportional hazards regression analysis with and without adjustment for age was used to examine the association between pregnancy and outcomes.
Among 1013 female patients with CeAD (median [IQR] age, 42 [35-48] years), 114 (11.3%) became pregnant during a median (IQR) follow-up of 5.3 (2.0-11.3) years. The composite outcome occurred in 10 of 114 patients (8.8%), including 7 patients with recurrent CeADs, 2 with ischemic strokes, and 1 with intracerebral hemorrhage, in the pregnancy group compared with 65 of 899 patients (7.2%), including 32 with recurrent CeAD, 26 with ischemic strokes, 4 with intracerebral hemorrhages, and 5 deaths (2 patients had 2 outcomes), in the nonpregnancy group (unadjusted hazard ratio, 1.08; 95% CI, 0.56-2.08; age-adjusted hazard ratio, 0.77; 95% CI, 0.38-1.56). Five of 10 events in the pregnancy group occurred post partum (4 CeADs and 1 stroke). Age-adjusted hazard ratios for secondary outcomes were 1.03 (95% CI, 0.43-2.46) for recurrent CeAD, 0.53 (95% CI, 0.13-2.12) for ischemic stroke, 1.01 (95% CI, 0.11-9.32) for intracerebral hemorrhage, and 0.90 (95% CI, 0.03-24.88) for death.
In this cohort study of women with a history of CeAD, becoming pregnant was not associated with an increased risk of recurrent CeAD, stroke, or death. These findings may be helpful for individual counseling and family planning for women with prior CeAD.
颈动脉夹层（CeAD）是年轻人中风的主要原因，且可发生于孕期。对于既往有CeAD的女性，尚不清楚未来怀孕是否会增加复发性CeAD、中风或死亡的风险。
比较怀孕的CeAD患者与未怀孕的CeAD患者发生复发性CeAD、中风或死亡这一复合结局的频率。
设计、设置和参与者：怀孕后复发性颈动脉夹层和中风的长期风险（LONG - RECAP）研究是一项国际性、多中心、基于登记的探索性队列研究，数据来自1990年5月1日至2023年4月30日期间9个国家33个中风中心的CeAD患者，这些患者至少有6个月的随访期，且有关于后续是否怀孕及结局事件发生情况的详细信息。
CeAD后怀孕。
初次CeAD后至少6个月随访期间复发性CeAD、中风（任何类型）和死亡（所有原因）的复合结局。次要结局是复合结局的组成部分。使用未调整年龄和调整年龄的Cox比例风险回归分析来检验怀孕与结局之间的关联。
在1013例女性CeAD患者中（年龄中位数[四分位间距]为42[35 - 48]岁），114例（11.3%）在中位（四分位间距）5.3（2.0 - 11.3）年的随访期间怀孕。怀孕组114例患者中有10例（8.8%）发生了复合结局，包括7例复发性CeAD、2例缺血性中风和1例脑出血；未怀孕组899例患者中有65例（7.2%）发生了复合结局，包括32例复发性CeAD、26例缺血性中风、4例脑出血和5例死亡（2例患者有2种结局）（未调整风险比为1.08；95%置信区间为0.56 - 2.08；年龄调整后风险比为0.77；95%置信区间为0.38 - 1.56）。怀孕组10例事件中有5例发生在产后（4例CeAD和1例中风）。复发性CeAD的年龄调整后风险比为1.03（95%置信区间为0.43 - 2.46），缺血性中风为0.53（95%置信区间为0.13 - 2.12），脑出血为1.01（95%置信区间为0.11 - 9.32），死亡为0.90（95%置信区间为0.03 - 24.88）。
在这项针对有CeAD病史女性的队列研究中，怀孕与复发性CeAD、中风或死亡风险增加无关。这些发现可能有助于对既往有CeAD病史的女性进行个体咨询和计划生育。
