Published Online
on February 16, 2006

A more recent version of this article appeared on April 1, 2006

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Submitted on October 3, 2005
Revised on November 2, 2005
Accepted on November 15, 2005

Preeclampsia and the Risk of Ischemic Stroke Among Young Women. Results From the Stroke Prevention in Young Women Study

David W. Brown MSPH, MSc^*; Nicole Dueker BSc; Denise J. Jamieson MD, MPH; John W. Cole MD; Marcella A. Wozniak MD, PhD; Barney J. Stern MD; Wayne H. Giles MD, MSc; and Steven J. Kittner MD, MPH

From the Centers for Disease Control and Prevention (D.W.B., D.J.J., W.H.G.), Atlanta, Ga; and the University of Maryland School of Medicine and Baltimore Department of Veterans Affairs Medical Center (N.D., J.W.C., M.A.W., B.J.S., S.J.K.), Baltimore, Md.

^* To whom correspondence should be addressed. E-mail: dbrown6{at}cdc.gov.

Background and Purpose--Preeclampsia is a pregnancy-specific systemic syndrome of unknown cause that affects 3% to 8% of pregnancies in the United States. Although preeclampsia is known to be an important risk factor for pregnancy-associated stroke, few data exist with regard to its association with stroke not occurring during pregnancy or the postpartum period.

Methods--Using data from the Stroke Prevention in Young Women Study (SPYW), a population-based case-control study of risk factors for ischemic stroke in women aged 15 to 44 years (recruitment period: 1992 to 1996, SPYW-1; 2001 to 2003, SPYW-2), we examined the independent association between a history of preeclampsia and the likelihood of ischemic stroke. Odds ratios (ORs) and 95% CIs were estimated using logistic regression. Cases (n=261) were women with stroke in the greater Baltimore-Washington area, and controls (n=421) were women free of a history of stroke identified by random digit dialing. Women who were pregnant at the time of stroke, those whose stroke occurred within 42 days postpartum, and nulligravida women were excluded from the analysis.

Results--The prevalence of preeclampsia among cases and controls was 15% (SPYW-1: 16%; SPYW-2: 15%) and 10% (SPYW-1: 10%; SPYW-2: 11%), respectively. Preeclampsia was associated with an increased likelihood of ischemic stroke (crude OR: 1.59; 95% CI: 1.00 to 2.52). After multivariable adjustment for age, race, education, and number of pregnancies, women with a history of preeclampsia were 60% more likely to have a nonpregnancy-related ischemic stroke than those without a history of preeclampsia (OR: 1.63; 95% CI: 1.02 to 2.62). Similar patterns were observed for women who reported symptoms of preeclampsia (elevated blood pressure and proteinuria).

Conclusion--These results suggest an association between a history of preeclampsia and ischemic stroke remote from pregnancy. If these results are confirmed in other studies, evaluation of the importance of targeting women with preeclampsia for close risk factor monitoring and control beyond the postpartum period may be warranted.

Key words: case control studies • cerebrovascular accident • preeclampsia • women’s health

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