Eliza C Miller1, Hajere J Gatollari2, Gloria Too2, Amelia K Boehme2, Lisa Leffert2, Randolph S Marshall2, Mitchell S V Elkind2, Joshua Z Willey2. 1. From the Department of Neurology, College of Physicians and Surgeons (E.C.M., A.K.B., R.S.M., M.S.V.E., J.Z.W.), Department of Epidemiology, Mailman School of Public Health (H.J.G., A.K.B., M.S.V.E.), and Department of Obstetrics and Gynecology (G.T.), Columbia University, New York, NY; and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston (L.L.). ecm2137@cumc.columbia.edu. 2. From the Department of Neurology, College of Physicians and Surgeons (E.C.M., A.K.B., R.S.M., M.S.V.E., J.Z.W.), Department of Epidemiology, Mailman School of Public Health (H.J.G., A.K.B., M.S.V.E.), and Department of Obstetrics and Gynecology (G.T.), Columbia University, New York, NY; and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston (L.L.).
Abstract
BACKGROUND AND PURPOSE: Preeclampsia affects 3% to 8% of pregnancies and increases risk of pregnancy-associated stroke (PAS). Data are limited on which women with preeclampsia are at highest risk for PAS. METHODS: Using billing data from the 2003 to 2012 New York State Department of Health inpatient database, we matched women with preeclampsia and PAS 1:3 to preeclamptic controls based on age and race/ethnicity. Pre-defined PAS risk factors included pregnancy complications, infection present on admission, vascular risk factors, prothrombotic states, and coagulopathies. We constructed multivariable conditional logistic regression models to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for independent risk factors for PAS. RESULTS: Among women aged 12 to 55 years admitted to New York State hospitals for any reason during the study period (n=3 373 114), 88 857 had preeclampsia, and 197 of whom (0.2%) had PAS. In multivariable analysis, women with preeclampsia and stroke were more likely than controls to have severe preeclampsia or eclampsia (OR, 7.2; 95% confidence interval [CI], 4.6-11.3), infections present on admission (OR, 3.0; 95% CI, 1.6-5.8), prothrombotic states (OR, 3.5; 95% CI, 1.3-9.2), coagulopathies (OR, 3.1; 95% CI, 1.3-7.1), or chronic hypertension (OR, 3.2; 95% CI, 1.8-5.5). Additional analyses matched and stratified by severity of preeclampsia confirmed these results. CONCLUSIONS: Infections, chronic hypertension, coagulopathies, and underlying prothrombotic conditions increase PAS risk in women with preeclampsia. These women may warrant closer monitoring.
BACKGROUND AND PURPOSE:Preeclampsia affects 3% to 8% of pregnancies and increases risk of pregnancy-associated stroke (PAS). Data are limited on which women with preeclampsia are at highest risk for PAS. METHODS: Using billing data from the 2003 to 2012 New York State Department of Health inpatient database, we matched women with preeclampsia and PAS 1:3 to preeclamptic controls based on age and race/ethnicity. Pre-defined PAS risk factors included pregnancy complications, infection present on admission, vascular risk factors, prothrombotic states, and coagulopathies. We constructed multivariable conditional logistic regression models to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for independent risk factors for PAS. RESULTS: Among women aged 12 to 55 years admitted to New York State hospitals for any reason during the study period (n=3 373 114), 88 857 had preeclampsia, and 197 of whom (0.2%) had PAS. In multivariable analysis, women with preeclampsia and stroke were more likely than controls to have severe preeclampsia or eclampsia (OR, 7.2; 95% confidence interval [CI], 4.6-11.3), infections present on admission (OR, 3.0; 95% CI, 1.6-5.8), prothrombotic states (OR, 3.5; 95% CI, 1.3-9.2), coagulopathies (OR, 3.1; 95% CI, 1.3-7.1), or chronic hypertension (OR, 3.2; 95% CI, 1.8-5.5). Additional analyses matched and stratified by severity of preeclampsia confirmed these results. CONCLUSIONS: Infections, chronic hypertension, coagulopathies, and underlying prothrombotic conditions increase PAS risk in women with preeclampsia. These women may warrant closer monitoring.
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