Karoliina Aarnio1,2, Mika Gissler3,4, Ulrike Grittner5,6, Bob Siegerink5, Markku Kaste1,2, Turgut Tatlisumak1,2,7,8, Minna Tikkanen9, Jukka Putaala1,2. 1. Clinical Neurosciences, Neurology, University of Helsinki, Finland. 2. Department of Neurology, Helsinki University Hospital, Finland. 3. National Institute for Health and Welfare, Finland. 4. Karolinska Institute, Sweden. 5. Center for Stroke Research Berlin (CSB) Charité Universitätsmedizin Berlin, Germany. 6. Department of Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Germany. 7. Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden. 8. Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. 9. Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland.
Abstract
INTRODUCTION: Limited data exist on the outcome of pregnancies and deliveries in women with ischaemic stroke. We investigated the incidence of pregnancy- and delivery-related complications in women with ischaemic stroke before and after pregnancy compared with stroke-free matched controls. PATIENTS AND METHODS: Of our 1008 consecutive patients aged 15-49 years with first-ever ischaemic stroke, 1994-2007, we included women with pregnancy data before or after stroke recorded in the Medical Birth Register (MBR) (n = 152), and for them searched stroke-free controls matched by age, parity, year of birth, residential area and multiplicity (n = 608). Data on hospital admissions and deaths (1987-2014) came from national health registries. Poisson regression mixed models allowed comparison of the incidence of complications. RESULTS: A total of 124 stroke mothers had 207 singleton pregnancies before and 45 mothers 68 pregnancies after stroke. The incidence rate ratio (IRR) for the composite outcome of pregnancy and delivery complications adjusted for socioeconomic status and maternal smoking was 1.43 (95% confidence interval [CI] 1.00-2.03, p = 0.05) for pre-stroke mothers, and 1.09 (95% CI 0.66-1.78) for post-stroke mothers, compared with matched controls. Similarly, the adjusted IRR for post-stroke hospital admission during pregnancy was 1.85 (95% CI 1.03-3.31). The IRR for perinatal death of the child was 3.43 (95% CI 0.57-20.53) before and 8.88 (95% CI 0.81-97.95) after stroke. DISCUSSION AND CONCLUSIONS: Compared with stroke-free mothers, we found a higher incidence of pregnancy- and delivery-related complications in mothers with ischaemic stroke. Larger studies are needed to verify our results.
INTRODUCTION: Limited data exist on the outcome of pregnancies and deliveries in women with ischaemic stroke. We investigated the incidence of pregnancy- and delivery-related complications in women with ischaemic stroke before and after pregnancy compared with stroke-free matched controls. PATIENTS AND METHODS: Of our 1008 consecutive patients aged 15-49 years with first-ever ischaemic stroke, 1994-2007, we included women with pregnancy data before or after stroke recorded in the Medical Birth Register (MBR) (n = 152), and for them searched stroke-free controls matched by age, parity, year of birth, residential area and multiplicity (n = 608). Data on hospital admissions and deaths (1987-2014) came from national health registries. Poisson regression mixed models allowed comparison of the incidence of complications. RESULTS: A total of 124 stroke mothers had 207 singleton pregnancies before and 45 mothers 68 pregnancies after stroke. The incidence rate ratio (IRR) for the composite outcome of pregnancy and delivery complications adjusted for socioeconomic status and maternal smoking was 1.43 (95% confidence interval [CI] 1.00-2.03, p = 0.05) for pre-stroke mothers, and 1.09 (95% CI 0.66-1.78) for post-stroke mothers, compared with matched controls. Similarly, the adjusted IRR for post-stroke hospital admission during pregnancy was 1.85 (95% CI 1.03-3.31). The IRR for perinatal death of the child was 3.43 (95% CI 0.57-20.53) before and 8.88 (95% CI 0.81-97.95) after stroke. DISCUSSION AND CONCLUSIONS: Compared with stroke-free mothers, we found a higher incidence of pregnancy- and delivery-related complications in mothers with ischaemic stroke. Larger studies are needed to verify our results.
Entities:
Keywords:
Ischaemic; delivery; outcome; pregnancy; stroke; young
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