Risk Factors for Pregnancy-Associated Stroke in Women With Preeclampsia

• DOI: 10.1161/strokeaha.117.017374
• Publication Date: 2017-05-26T00:55:28Z
• Authors: Eliza C. Miller; Hajere J. Gatollari; Gloria Too; Amelia K. Boehme; Lisa Leffert; Randolph S. Marshall; Mitchell S.V. Elkind; Joshua Z. Willey
• Keywords: Adult; Adolescent; New York; Communicable Diseases; 3. Good health; Stroke; Young Adult; 03 medical and health sciences; Patient Admission; 0302 clinical medicine; Pre-Eclampsia; Pregnancy; Risk Factors; Case-Control Studies; Hypertension; Humans; Female

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.