Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk

Chun An Cheng, Jiunn Tay Lee, Hung Che Lin, Hui Chen Lin, Chi Hsiang Chung, Fu Huang Lin, Chang Huei Tsao, Yung Fu Wu, Wu Chien Chien, Hung Wen Chiu

Research output: Contribution to journalArticle

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Abstract

Background: The incidence of stroke in pregnant women is low but trending upward. There are few studies of the topic in women of Asian ethnicity. Aim: We aim to evaluate stroke risk in Asian women during and after pregnancy. Design: Using the Taiwan National Health Insurance database, we designed a retrospective study that included 18-45-yearold pregnant women between the years 2000 and 2010. We selected a 1:1 age-matched control group of non-pregnant women. The endpoint was any type of stroke during pregnancy or the postpartumperiod; otherwise, the patients were tracked until 31 December 2010. Methods: The risk factors for stroke were found using Cox proportional regression to calculate the hazard ratio (HR) with a 95% CI compared with the control group. Results: The incidence of stroke within 1 year postpartumwas 71/100,000. The risk of postpartum stroke within 1 year was an HR of 1.208 (95% CI: 1.001-5.129). The occurrence of stroke was associated with hypertension, diabetes mellitus, coagulation disorders, migraine, obesity, cerebrovascular malformation and parity. Women with third and fourth parity carried increased risks of 13.3% and 2.5%, respectively, compared with first parity women. In long-term follow-ups, stroke risk was significantly lower, with an adjusted HR of 0.362 (95% CI: 0.269-0.489). Conclusion: The risk of stroke was elevated during the first year postpartum, but lower in subsequent years. Stroke risk increased in multiparous (≥ 3) women. Physicians should be on alert for pregnancy complications and ensure appropriate management to prevent postpartum stroke.

Original languageEnglish
Pages (from-to)355-360
Number of pages6
JournalQJM
Volume110
Issue number6
DOIs
Publication statusPublished - 2017

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Postpartum Period
Stroke
Pregnancy
Parity
Pregnant Women
Control Groups
Pregnancy Complications
Incidence
National Health Programs
Migraine Disorders
Taiwan
Diabetes Mellitus
Research Design
Retrospective Studies
Obesity
Databases
Hypertension
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cheng, C. A., Lee, J. T., Lin, H. C., Lin, H. C., Chung, C. H., Lin, F. H., ... Chiu, H. W. (2017). Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk. QJM, 110(6), 355-360. https://doi.org/10.1093/qjmed/hcw222

Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk. / Cheng, Chun An; Lee, Jiunn Tay; Lin, Hung Che; Lin, Hui Chen; Chung, Chi Hsiang; Lin, Fu Huang; Tsao, Chang Huei; Wu, Yung Fu; Chien, Wu Chien; Chiu, Hung Wen.

In: QJM, Vol. 110, No. 6, 2017, p. 355-360.

Research output: Contribution to journalArticle

Cheng, CA, Lee, JT, Lin, HC, Lin, HC, Chung, CH, Lin, FH, Tsao, CH, Wu, YF, Chien, WC & Chiu, HW 2017, 'Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk', QJM, vol. 110, no. 6, pp. 355-360. https://doi.org/10.1093/qjmed/hcw222
Cheng CA, Lee JT, Lin HC, Lin HC, Chung CH, Lin FH et al. Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk. QJM. 2017;110(6):355-360. https://doi.org/10.1093/qjmed/hcw222
Cheng, Chun An ; Lee, Jiunn Tay ; Lin, Hung Che ; Lin, Hui Chen ; Chung, Chi Hsiang ; Lin, Fu Huang ; Tsao, Chang Huei ; Wu, Yung Fu ; Chien, Wu Chien ; Chiu, Hung Wen. / Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk. In: QJM. 2017 ; Vol. 110, No. 6. pp. 355-360.
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abstract = "Background: The incidence of stroke in pregnant women is low but trending upward. There are few studies of the topic in women of Asian ethnicity. Aim: We aim to evaluate stroke risk in Asian women during and after pregnancy. Design: Using the Taiwan National Health Insurance database, we designed a retrospective study that included 18-45-yearold pregnant women between the years 2000 and 2010. We selected a 1:1 age-matched control group of non-pregnant women. The endpoint was any type of stroke during pregnancy or the postpartumperiod; otherwise, the patients were tracked until 31 December 2010. Methods: The risk factors for stroke were found using Cox proportional regression to calculate the hazard ratio (HR) with a 95{\%} CI compared with the control group. Results: The incidence of stroke within 1 year postpartumwas 71/100,000. The risk of postpartum stroke within 1 year was an HR of 1.208 (95{\%} CI: 1.001-5.129). The occurrence of stroke was associated with hypertension, diabetes mellitus, coagulation disorders, migraine, obesity, cerebrovascular malformation and parity. Women with third and fourth parity carried increased risks of 13.3{\%} and 2.5{\%}, respectively, compared with first parity women. In long-term follow-ups, stroke risk was significantly lower, with an adjusted HR of 0.362 (95{\%} CI: 0.269-0.489). Conclusion: The risk of stroke was elevated during the first year postpartum, but lower in subsequent years. Stroke risk increased in multiparous (≥ 3) women. Physicians should be on alert for pregnancy complications and ensure appropriate management to prevent postpartum stroke.",
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AU - Lin, Hung Che

AU - Lin, Hui Chen

AU - Chung, Chi Hsiang

AU - Lin, Fu Huang

AU - Tsao, Chang Huei

AU - Wu, Yung Fu

AU - Chien, Wu Chien

AU - Chiu, Hung Wen

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N2 - Background: The incidence of stroke in pregnant women is low but trending upward. There are few studies of the topic in women of Asian ethnicity. Aim: We aim to evaluate stroke risk in Asian women during and after pregnancy. Design: Using the Taiwan National Health Insurance database, we designed a retrospective study that included 18-45-yearold pregnant women between the years 2000 and 2010. We selected a 1:1 age-matched control group of non-pregnant women. The endpoint was any type of stroke during pregnancy or the postpartumperiod; otherwise, the patients were tracked until 31 December 2010. Methods: The risk factors for stroke were found using Cox proportional regression to calculate the hazard ratio (HR) with a 95% CI compared with the control group. Results: The incidence of stroke within 1 year postpartumwas 71/100,000. The risk of postpartum stroke within 1 year was an HR of 1.208 (95% CI: 1.001-5.129). The occurrence of stroke was associated with hypertension, diabetes mellitus, coagulation disorders, migraine, obesity, cerebrovascular malformation and parity. Women with third and fourth parity carried increased risks of 13.3% and 2.5%, respectively, compared with first parity women. In long-term follow-ups, stroke risk was significantly lower, with an adjusted HR of 0.362 (95% CI: 0.269-0.489). Conclusion: The risk of stroke was elevated during the first year postpartum, but lower in subsequent years. Stroke risk increased in multiparous (≥ 3) women. Physicians should be on alert for pregnancy complications and ensure appropriate management to prevent postpartum stroke.

AB - Background: The incidence of stroke in pregnant women is low but trending upward. There are few studies of the topic in women of Asian ethnicity. Aim: We aim to evaluate stroke risk in Asian women during and after pregnancy. Design: Using the Taiwan National Health Insurance database, we designed a retrospective study that included 18-45-yearold pregnant women between the years 2000 and 2010. We selected a 1:1 age-matched control group of non-pregnant women. The endpoint was any type of stroke during pregnancy or the postpartumperiod; otherwise, the patients were tracked until 31 December 2010. Methods: The risk factors for stroke were found using Cox proportional regression to calculate the hazard ratio (HR) with a 95% CI compared with the control group. Results: The incidence of stroke within 1 year postpartumwas 71/100,000. The risk of postpartum stroke within 1 year was an HR of 1.208 (95% CI: 1.001-5.129). The occurrence of stroke was associated with hypertension, diabetes mellitus, coagulation disorders, migraine, obesity, cerebrovascular malformation and parity. Women with third and fourth parity carried increased risks of 13.3% and 2.5%, respectively, compared with first parity women. In long-term follow-ups, stroke risk was significantly lower, with an adjusted HR of 0.362 (95% CI: 0.269-0.489). Conclusion: The risk of stroke was elevated during the first year postpartum, but lower in subsequent years. Stroke risk increased in multiparous (≥ 3) women. Physicians should be on alert for pregnancy complications and ensure appropriate management to prevent postpartum stroke.

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