How Does Risk of Stroke Following Childbirth Differ Based on Hypertensive Disorder of Pregnancy Subtype? How Does Risk Change Over Time for Hemorrhagic and Ischemic Stroke?
Hannah Roeder, MD, MPH
Hung S-K, Lee M-S, Lin H-Y, Chen L-C, Chuang C-J, Chew C-H, Yu B-H, Yang H-J, Hsu F-C, Chiou W-Y. Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time. Stroke. 2022.
Hypertensive disorders of pregnancy (HDP) are a common obstetric complication and are associated with an increased risk of vascular disease later in life. Hung et al. investigate whether the four subtypes of HDP (1. chronic hypertension (HTN), 2. chronic HTN with superimposed preeclampsia, 3. preeclampsia/eclampsia, and 4. gestational HTN) lead to different patterns of subsequent ischemic and hemorrhagic stroke.
The authors employed the Taiwan National Health Insurance Research Database to identify pregnancies in women aged 18 to 45 years old (without a prior history of stroke) between the years 2000 and 2017. Exact matching (of age, delivery method, gestation number, hospital level, delivery season, geographic area, income, and co-morbidities) was employed to recruit HDP patients and controls in a 1:4 ratio. Firstly, 17,588 women with HDP were initially identified, but after exact matching 13,617 were included. Adjusted hazard ratios for ischemic and hemorrhagic stroke were calculated, and a stratified analyses of stroke risk for the four HDP subtypes were performed. The authors also stratified risk by follow-up time after childbirth.