Stroke and Cerebrovascular Disease in Pregnancy: Incidence, Temporal Trends, and Risk Factors

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dc.contributor.author

Liu, Shiliang

Chan, Wee-Shian

Ray, Joel G.

Kramer, Michael S.

Joseph, K. S.

dc.date.accepted

2018-10-08

dc.date.accessioned

2024-11-21T15:30:25Z

dc.date.available

2024-11-21T15:30:25Z

dc.date.issued

2018-11-21

dc.description.abstract - en

BACKGROUND AND PURPOSE— Few studies have examined the epidemiology of stroke in pregnancy, despite the high associated burden of death and disability. We aimed to quantify the incidence, temporal trends, risk factors, and case fatality associated with stroke and cerebrovascular disease in pregnancy. METHODS— All antepartum, peripartum, and postpartum hospitalizations and readmissions within 42 days of delivery in Canada (except Quebec) were obtained from the Canadian Institute of Health Information for the years 2003 to 2016. We assessed temporal trends in stroke and quantified associated risk factors using logistic regression. RESULTS— Five hundred twenty-four stroke cases were identified among 3 907 262 deliveries (13.4 per 100 000). The majority of cases were hemorrhagic strokes (307 cases, 58.6%) and most occurred in the postpartum period (270 cases, 51.5%). The case fatality rate was 7.4%. Stroke incidence rose from 10.8 per 100 000 in 2003 to 2004 to 16.6 per 100 000 deliveries in 2015 to 2016 (P=0.002). Risk factors for stroke included older maternal (age ≥40 years; adjusted odds ratio [AOR], 1.7; 95% CI, 1.1–2.6), preeclampsia (AOR, 7.1; 95% CI, 5.3–9.6), eclampsia (AOR, 65.9; 95% CI, 43.6–99.6), maternal congenital heart disease (AOR, 38.1; 95% CI, 22.1–65.8), connective tissue disorders (AOR, 12.6; 95% CI, 6.1–26.9), sepsis (AOR, 7.6; 95% CI, 3.6–16.2), severe postpartum hemorrhage (AOR, 4.7; 95% CI, 2.8–8.0), and thrombophilia (AOR, 4.2; 95% CI, 1.5–12.1). CONCLUSIONS— The rising incidence of stroke in pregnancy, especially during the postpartum period, and its strong association with hypertensive disorders of pregnancy (especially preeclampsia) suggest that follow-up of severe hypertensive patients is required after delivery.

dc.identifier.citation

Liu S, Chan WS, Ray JG, Kramer MS, Joseph KS. Stroke and Cerebrovascular Disease in Pregnancy. Stroke. 2019;50(1):13-20. doi:https://doi.org/10.1161/strokeaha.118.023118

dc.identifier.doi

https://doi.org/10.1161/STROKEAHA.118.023118

dc.identifier.uri

https://open-science.canada.ca/handle/123456789/3170

dc.language.iso

en

dc.publisher - en

AHA/ASA Journals

dc.rights - en

None

dc.rights - fr

Aucune

dc.rights.uri - en

No License

dc.rights.uri - fr

Aucune Licence

dc.subject - en

Health

Pregnancy

dc.subject - fr

Santé

Grossesse

dc.subject.en - en

Health

Pregnancy

dc.subject.fr - fr

Santé

Grossesse

dc.title - en

Stroke and Cerebrovascular Disease in Pregnancy: Incidence, Temporal Trends, and Risk Factors

dc.type - en

Accepted manuscript

dc.type - fr

Manuscrit accepté

local.article.journalissue

1

local.article.journaltitle - en

Stroke

local.article.journalvolume

50

local.pagination

13-20

local.peerreview - en

Yes

local.peerreview - fr

Oui