Introduction: Pregnancy-associated stroke (PAS) remains among the leading causes of maternal morbidity and mortality. Up to 20% of women with PAS have preeclampsia or eclampsia (PEC). However, PEC is relatively common (∼3.4% of pregnancies), while PAS is rare (∼20 per 100,000 deliveries). It is not clear what risk factors differentiate women with PEC who develop PAS.
Hypothesis: Identifying risk factors for stroke in women with PEC could help identify women at highest risk for PAS.
Methods: We used the 2008-2012 New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) inpatient sample database to identify pregnant or postpartum women (APR MDC 14) aged 12-50 with mild to severe preeclampsia (642.4x-642.5x) or eclampsia (642.6x). We compared non-stroke PEC patients (controls) to those with ischemic (ICD-9 433.xx, 434.xx, 436), ICH (ICD-9 431), SAH (ICD-9 430), and non-specified pregnancy-related strokes, including post-partum stroke (ICD-9 671.7, 674.0-674.4). Risk factors included delivery type (C-section vs vaginal), age, multigravida, primary hypercoagulable state, pre-existing diabetes, obesity and migraine. The associations between risk factors and stroke were evaluated using generalized estimating equation logistic regression adjusting for patients’ re-hospitalizations to calculate odds ratios and 95% confidence intervals (OR, 95%CI) for stroke .
Results: There were 85 stroke cases and 41,634 PEC controls without stroke. A majority of strokes in PEC patients occurred postpartum (n=76, 89.4%). Stroke patients were more likely to have eclampsia (OR: 24.7, 95%CI: 15.6-39.3) or severe pre-eclampsia (OR: 1.6, 95%CI: 1.0-2.5) compared to non-stroke patients. In multivariable analyses, being multigravida (OR: 1.4, 95%CI 1.3-1.6), primary hypercoagulable state (OR:2.1, 95%CI 1.8-2.4) and migraine (OR 2.3, 95%CI 2.1-2.5) were also risk factors for stroke.
Conclusions: Women with eclampsia were at at the highest risk for pregnancy-associated stroke. Several other risk factors for stroke in women with preeclampsia may also help identify women who warrant closer monitoring for neurological symptoms in the peripartum period.