Key result
Pregnancy-associated stroke was associated with a higher hazard of death and readmission compared with pregnant patients without stroke at 1-year follow-up (HR 5.70; 95% CI 3.04-10.66).
Why the study?
Pregnancy-associated stroke carries high short-term morbidity and mortality, but data on subsequent maternal outcomes are limited.
Does pregnancy-associated stroke increase the long-term risk of death and all-cause readmission compared to non-pregnant stroke patients or pregnant patients without stroke?
Cohort (n=1,504,077)
Does pregnancy-associated stroke increase the long-term risk of death and all-cause readmission compared to non-pregnant stroke patients or pregnant patients without stroke?
Hazard Ratio: 5.7 (95% CI 3.04–10.66)
Pregnancy-associated stroke carries a significantly higher long-term risk of death and readmission compared to pregnancy without stroke, highlighting the need for extended postpartum vascular care.
BACKGROUND: Pregnancy-associated stroke carries high short-term morbidity and mortality, but data on subsequent maternal outcomes are limited. We evaluated long-term maternal health outcomes after pregnancy-associated stroke. METHODS: In this retrospective cohort study, we used administrative data to identify pregnant adults aged ≤49 years with stroke between 2002-2020 in Ontario, Canada and 2 comparison groups: (1) non-pregnant female patients with stroke and (2) pregnant patients without stroke. Patients who survived the index admission were followed until 2021. After propensity score matching, we used Cox regression with a robust variance estimator to compare pregnant patients with stroke and the 2 comparison groups for the composite outcome of death and all-cause non-pregnancy readmission. Where proportional hazard assumption was not met, we reported time-varying hazard ratios (HR) with 95% CIs by modeling the log-hazard ratio as a function of time using restricted cubic splines. RESULTS: We identified 217 pregnant patients with stroke, 7604 non-pregnant patients with stroke, and 1 496 256 pregnant patients without stroke. Of the 202 pregnant patients with stroke who survived the index stroke admission, 41.6% (6.8 per 100 person-years) subsequently died or were readmitted during follow-up. Median follow-up times were 5 years (pregnancy-associated stroke), 3 years (non-pregnant stroke), and 8 years (pregnant without stroke). Pregnant patients with stroke had a lower hazard of death and all-cause readmission compared with non-pregnant patients with stroke at 1-year follow-up (HR, 0.64 [95% CI, 0.44-0.94]), but this association did not persist during longer-term follow-up. Conversely, pregnant patients with stroke had higher hazard of death and readmission compared with pregnant patients without stroke at 1-year follow-up (HR, 5.70 [95% CI, 3.04-10.66]), and this association persisted for a decade. CONCLUSIONS: Stroke during pregnancy is associated with long-term health consequences. It is essential to transition care postpartum to primary or specialty care to optimize vascular health.
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Yu et al. (2023) conducted a cohort in Pregnancy-associated stroke (n=1,504,077). Pregnancy-associated stroke vs. Pregnant patients without stroke and non-pregnant patients with stroke was evaluated on Composite outcome of death and all-cause non-pregnancy readmission (HR 5.70, 95% CI 3.04-10.66). Pregnancy-associated stroke was associated with a higher hazard of death and readmission compared with pregnant patients without stroke at 1-year follow-up (HR 5.70; 95% CI 3.04-10.66).
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