on February 19, 2009
Published online before print February 19, 2009, doi: 10.1161/STROKEAHA.108.540880
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Submitted on October 27, 2008
From the School of Health Care Administration (C.-H.T., S.-T.H.), Taipei Medical University, Taipei, Taiwan; the Gynecology Research Center (C.-H.T.), Taipei Medical University Hospital, Taipei, Taiwan; the Department of Otolaryngology (C.-S.W.), Taipei City Hospital, Zhong Xing Branch, Taipei, Taiwan; the Department of Health Services Policy and Management (C.-S.W.), University of South Carolina, Columbia, SC, USA; the Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan; the Division of Graduate Medical Sciences (C.-Y.C.Y.), Boston University School of Medicine, Boston, Mass, USA; the Graduate Institute of Health Care Administration (C.-H.L.), National Yang Ming University, Taipei, Taiwan; the Bureau of National Health Insurance (C.-H.L.), Department of Health, Taipei, Taiwan; and the Division of Cardiology (P.-H.C.), Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan. * To whom correspondence should be addressed. E-mail: pchu{at}adm.cgmh.org.tw.
Background and Purpose—The occurrence of preeclampsia-eclampsia during pregnancy has been reported to increase the risk of stroke in mainly Western populations. However, few studies have evaluated stroke risk in Asian populations and followed women beyond the early postpartum period. Thus, the present study determined the risk of stroke in women in Taiwan during pregnancy and the first postpartum year. Methods—A population-based cohort study was performed on 1 132 019 parturients during 1999 to 2003 using a dataset linking birth certificates and National Health Insurance hospital discharge data. Stroke-free survival rates were estimated using the Kaplan–Meier method, and the log-rank test was used to examine the effect of preelampsia-eclampsia on the prevalence of stroke. Sociodemographic factors and obstetric complications were used in multivariate logistic regression models to determine the adjusted odds ratios of preeclampsia-eclampsia on the risk of hemorrhagic and ischemic stroke during pregnancy and within the first postpartum year. Results—The incidence of stroke was 21.47 cases per 100 000 deliveries. There were 139 cases of hemorrhagic stroke and 107 cases of ischemic stroke. The respective adjusted relative risk of preeclampsia-eclampsia for hemorrhagic and ischemic stroke were 10.68 (95% CI, 3.40 to 33.59) and 40.86 (95% CI, 12.14 to 137.47) within 3 months antepartum; 6.45 (95% CI, 1.42 to 29.29) and 34.71 (95% CI, 11.08 to 108.68) in the first 3 days postpartum; 5.61 (95% CI, 0.71 to 44.10) and 11.23 (95% CI, 2.45 to 51.59) from 3 days to 6 weeks postpartum; 11.76 (95% CI, 4.05 to 34.11) and 11.60 (95% CI, 3.30 to 40.82) from 6 weeks to 6 months pospartum; and 19.90 (95% CI, 7.75 to 51.11) and 4.35 (95% CI, 0.58 to 32.92) from 6 months to 12 months postpartum. Conclusions—Women with preeclampsia-eclampsia have a significantly higher risk of stroke during pregnancy and in the first postpartum year. These results suggest that women with preeclampsia-eclampsia should be closely monitored even after pregnancy.
Revised on January 24, 2009
Accepted on January 30, 2009
Preeclampsia-Eclampsia and the Risk of Stroke Among Peripartum in Taiwan
Chao-Hsiun Tang PhD;
Key words: stroke in young adults • preeclampsia-eclampsia • Taiwan
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