Eliza C Miller1, Marisa Gallo2,3, Erin R Kulick4,2, Alexander M Friedman5, Mitchell S V Elkind4,2, Amelia K Boehme4,2. 1. From the Department of Neurology, Vagelos College of Physicians and Surgeons (E.C.M., E.R.K., M.S.V.E., A.K.B.) ecm2137@cumc.columbia.edu. 2. Department of Epidemiology, Mailman School of Public Health (M.G., E.R.K., M.S.V.E., A.K.B.). 3. Columbia University, New York, NY; and Pfizer, Inc, New York, NY (M.G.). 4. From the Department of Neurology, Vagelos College of Physicians and Surgeons (E.C.M., E.R.K., M.S.V.E., A.K.B.). 5. Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons (A.M.F.).
Abstract
BACKGROUND AND PURPOSE: Peripartum strokes during delivery admissions are rare but have high maternal morbidity. Infections have been proposed as a possible stroke trigger. We hypothesized that women who had infections diagnosed at the time of delivery admission would have higher risk of stroke during their delivery hospitalization. METHODS: We conducted a case-control study using state inpatient administrative databases for California (2007-2011), Florida (2009-2011), and New York (2009-2011). Women whose admission included a vaginal or cesarean delivery, with a new diagnosis of stroke during the admission, were considered cases and were randomly matched to 3 in-state controls by age/admission year and presence and severity of hypertensive disorders of pregnancy. The primary exposure of interest was infection of any type present on admission. Secondary exposures included race/ethnicity, payer status, delivery method, and known vascular risk factors such as chronic hypertension, diabetes mellitus, smoking, alcohol abuse, hypercoagulable states, coagulopathies, and renal disease. We used multivariable conditional logistic regression to estimate the odds ratios and 95% confidence intervals for the association of infections and known vascular risk factors with stroke risk. RESULTS: A total of 455 cases (mean age, 29.8), of whom 195 (42.9%) had hypertensive disorders of pregnancy, were matched with 1365 controls. Infection of any type present on admission increased the odds of stroke diagnosis during the admission (adjusted odds ratio, 1.74; 95% confidence interval, 1.29-2.35). Risk was higher for genitourinary infections (adjusted odds ratio, 2.56; 95% confidence interval, 1.25-5.24) and sepsis (adjusted odds ratio, 10.4; 95% confidence interval, 2.15-20.0). The association between infection and stroke during delivery admission did not differ by the presence of hypertensive disorders of pregnancy. CONCLUSIONS: Infections present on admission increased stroke risk during delivery admissions in women with and without hypertensive disorders of pregnancy. The results were driven by genitourinary infections and sepsis. Infections may be an underrecognized precipitant of peripartum stroke.
BACKGROUND AND PURPOSE: Peripartum strokes during delivery admissions are rare but have high maternal morbidity. Infections have been proposed as a possible stroke trigger. We hypothesized that women who had infections diagnosed at the time of delivery admission would have higher risk of stroke during their delivery hospitalization. METHODS: We conducted a case-control study using state inpatient administrative databases for California (2007-2011), Florida (2009-2011), and New York (2009-2011). Women whose admission included a vaginal or cesarean delivery, with a new diagnosis of stroke during the admission, were considered cases and were randomly matched to 3 in-state controls by age/admission year and presence and severity of hypertensive disorders of pregnancy. The primary exposure of interest was infection of any type present on admission. Secondary exposures included race/ethnicity, payer status, delivery method, and known vascular risk factors such as chronic hypertension, diabetes mellitus, smoking, alcohol abuse, hypercoagulable states, coagulopathies, and renal disease. We used multivariable conditional logistic regression to estimate the odds ratios and 95% confidence intervals for the association of infections and known vascular risk factors with stroke risk. RESULTS: A total of 455 cases (mean age, 29.8), of whom 195 (42.9%) had hypertensive disorders of pregnancy, were matched with 1365 controls. Infection of any type present on admission increased the odds of stroke diagnosis during the admission (adjusted odds ratio, 1.74; 95% confidence interval, 1.29-2.35). Risk was higher for genitourinary infections (adjusted odds ratio, 2.56; 95% confidence interval, 1.25-5.24) and sepsis (adjusted odds ratio, 10.4; 95% confidence interval, 2.15-20.0). The association between infection and stroke during delivery admission did not differ by the presence of hypertensive disorders of pregnancy. CONCLUSIONS:Infections present on admission increased stroke risk during delivery admissions in women with and without hypertensive disorders of pregnancy. The results were driven by genitourinary infections and sepsis. Infections may be an underrecognized precipitant of peripartum stroke.
Authors: Eliza C Miller; Hajere J Gatollari; Gloria Too; Amelia K Boehme; Lisa Leffert; Randolph S Marshall; Mitchell S V Elkind; Joshua Z Willey Journal: Stroke Date: 2017-05-25 Impact factor: 7.914
Authors: Hooman Kamel; Babak B Navi; Nandita Sriram; Dominic A Hovsepian; Richard B Devereux; Mitchell S V Elkind Journal: N Engl J Med Date: 2014-02-13 Impact factor: 91.245
Authors: Alan T N Tita; Jeff M Szychowski; Kim Boggess; George Saade; Sherri Longo; Erin Clark; Sean Esplin; Kirsten Cleary; Ron Wapner; Kellett Letson; Michelle Owens; Adi Abramovici; Namasivayam Ambalavanan; Gary Cutter; William Andrews Journal: N Engl J Med Date: 2016-09-29 Impact factor: 91.245
Authors: Sarah Rae Easter; David E Cantonwine; Chloe A Zera; Kee-Hak Lim; Samuel I Parry; Thomas F McElrath Journal: Am J Obstet Gynecol Date: 2015-10-09 Impact factor: 8.661
Authors: Islam Y Elgendy; Syed Bukhari; Amr F Barakat; Carl J Pepine; Kathryn J Lindley; Eliza C Miller Journal: Circulation Date: 2021-02-15 Impact factor: 29.690
Authors: Anthoula C Tsolaki; Galaktion Konstantinidis; Stavroula Koukou; Fotini Michali; Despina Georgiadou; Thomas Tegos; Nikolaos D Michalis Journal: J Med Case Rep Date: 2021-06-15
Authors: Eliza C Miller; Maria Daniela Zambrano Espinoza; Yongmei Huang; Alexander M Friedman; Amelia K Boehme; Natalie A Bello; Kirsten L Cleary; Jason D Wright; Mary E D'Alton Journal: J Am Heart Assoc Date: 2020-01-24 Impact factor: 5.501
Authors: Pensée Wu; Kelvin P Jordan; Carolyn A Chew-Graham; Thais Coutinho; Gina P Lundberg; Ki E Park; Lucy C Chappell; Phyo K Myint; Angela H E M Maas; Mamas A Mamas Journal: J Am Heart Assoc Date: 2020-07-29 Impact factor: 5.501