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Infection raises risk of preeclampsia related stroke
Urinary tract infections, chronic high blood pressure, bleeding or clotting disorders may increase risk of stroke in women with preeclampsia, a high-blood pressure disorder unique to pregnancy. New research is published in the American Heart Association's journal Stroke.
Preeclampsia puts pregnant women at higher risk of stroke during pregnancy and after delivery which is why The American Heart Association recommends home blood pressure monitoring. But while preeclampsia affects 3 percent to 8 percent of all pregnancies, pregnancy-related stroke is still rare. However, greater than one in 10 of preeclampsia-related strokes are fatal.
In a study of women admitted to hospitals in New York State from 2003 through 2012, researchers identified 88,857 women with preeclampsia. Of that number, 197 had pregnancy-associated stroke.
Compared with women who had preeclampsia but did not have a stroke, women who had preeclampsia and pregnancy-associated stroke were:
• seven times more likely to have severe preeclampsia or eclampsia
• three times more likely to have infections upon arrival
• had high blood pressure before developing preeclampsia
• had blood disorders involving clots or excessive bleeding
"Our study sought to discover if there are other risk factors or clues that may help identify the women with preeclampsia who are at the highest risk for pregnancy-related stroke. We were looking for risk factors that could be prevented or treated," explains Eliza Miller MD, a Vascular Neurology Fellow at the New York-Presbyterian Hospital/Columbia University Medical Center in New York City, and study lead author.
Researchers compared women with preeclampsia and pregnancy-associated stroke to a matched control group of women with preeclampsia but no stroke, from the New York State Department of Health inpatient database. Among the women with preeclampsia and stroke, most strokes occurred postpartum, after discharge following delivery.
The study relied on patients' billing data and thus was limited in detail for analysis. This restricted researchers from drawing definitive conclusions. But associations were strong enough, Miller says, to generate new directions for more research.
"Preeclampsia is a very common disorder, and a lot of people are not aware of its association with stroke. Women with preeclampsia should take any neurological symptom, such as severe headache, very seriously, especially during the postpartum period. This needs to be a major focus of future stroke research in women."
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.
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.
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.
Infections, chronic hypertension, coagulopathies, and underlying prothrombotic conditions increase PAS risk in women with preeclampsia. These women may warrant closer monitoring.
Authors: Eliza C. Miller, Hajere J. Gatollari, Gloria Too, Amelia K. Boehme, Lisa Leffert, Randolph S. Marshall, Mitchell S.V. Elkind, Joshua Z. Willey
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"Women with preeclampsia should take any neurological symptom, such as severe headache, very seriously, especially during the postpartum period," says Elizabeth C. Miller MD.