Impact of Pre-eclampsia/eclampsia on Hemorrhagic and Ischemic Stroke
Risk: A 17 years Follow-up Nationwide Cohort Study
Abstract
Objective No study ever investigated the long-term risk of stroke in
women with pre-eclampsia/eclampsia. The purpose of this study is to
explore long-term stroke risks, differentiating subtypes and their time
trends. Design Nationwide population-based cohort study Methods Between
2000 and 2017, 1,384,427 pregnant women were registered in the National
Health Insurance Research Database in Taiwan. After excluding women with
previous stroke history and exact matching with all confounders, 6,053
women with pre-eclampsia/eclampsia and 24,212 controls were recruited.
Main Outcome Measures Hemorrhagic and ischemic strokes after child-birth
Results Over the 17-year follow-up, the adjusted hazard ratio (aHR) for
stroke in women with a history of pre-eclampsia/eclampsia was 2.05 (95%
confidence interval, CI = 1.67-2.52, p<0.001). The 17 years
overall risks of both ischemic and hemorrhagic stroke were 1.98 and
3.45, respectively (p<0.001). The stroke subtypes, hemorrhagic
and ischemic, had different time trend risks, and hemorrhagic stroke
risks kept higher than that of ischemic stroke. The ischemic stroke risk
peaked during 1-3 years after childbirth (aHR=3.09). The hemorrhagic
stroke risk peaked during 3-5 years (aHR=7.49). Conclusions Stroke risk
persisted even after decades, for both ischemic and hemorrhagic
subtypes. Women with pre-eclampsia/eclampsia history should be aware of
the long-term risk of stroke. Tweetable abstract Both ischemic and
hemorrhagic stroke risks persisted high even after decades, while their
time trend risks were different. Keywords: pre-eclampsia/eclampsia;
ischemic stroke; hemorrhagic stroke