ObstetricsPulmonary embolism and stroke in relation to pregnancy: How can high-risk women be identified?☆,☆☆
Section snippets
Patients and methods
We conducted the present population-based cohort study through cross-linkage of the nation-wide Swedish Inpatient and Birth Registers, held by the National Board of Health and Welfare. Individual record linkage between these registers was obtained by using the unique national registration number assigned to each Swedish resident. The coverage is 99% of the deliveries and inpatient care during the study period.15, 16
Results
Table I shows that pregnancy status, maternal age, parity, smoking, preeclampsia, multiple birth, diabetes, and cesarean delivery are all associated with risks of pulmonary embolism and stroke.Empty Cell Pulmonary embolism Stroke No.of cases RR CI No. of cases RR CI Period* Reference 148 1.0 Reference 196 1.0 Referemce Third trimester 29 3.2 2.1-4.7 26 2.1 1.4-3.2 Around delivery 34
Comment
The results of the present study demonstrate that preeclampsia, multiple birth, and cesarean delivery are associated with markedly increased risks of pulmonary embolism and stroke related to pregnancy and that these risks also increase with maternal age and smoking. However, these factors cannot explain the pregnancy-related risks of pulmonary embolism and stroke.
The detailed and individual data available from registers, with almost complete nationwide coverage of deliveries and inpatient care,
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Ischemic stroke and cerebral venous sinus thrombosis in pregnancy
2020, Handbook of Clinical NeurologyCitation Excerpt :Internationally, tobacco use during pregnancy varies from < 1% to as high as 18% and secondhand smoking exposure is often much higher (Bloch et al., 2008). In a Swedish cohort, the relative risk for maternal stroke in smokers was 2.4 times (95% CI 1.9–3.0) that of nonsmokers (Ros et al., 2002). In a hospital database in the United States, pregnant smokers were also found to have much greater risk of stroke, odds ratio 1.7 (95% CI 1.2–2.5) (Roelands et al., 2009).
Physiology of the cerebrovascular adaptation to pregnancy
2020, Handbook of Clinical NeurologyCitation Excerpt :Together, the venous remodeling reported to occur during pregnancy may increase the risk for both cerebral venous thrombosis and intracerebral hemorrhage that make up a substantial proportion of maternal mortality and cerebrovascular complications during this period. Moreover, cerebral venous remodeling may represent a mechanism by which preeclampsia, a state of exaggerated hypercoagulation, may further promote cerebral venous thrombosis and contribute to the 6–12-fold increased risk for stroke compared with normal pregnancy (Ros et al., 2002; Scott et al., 2012). Whether the outward hypotrophic venous remodeling has mechanisms similar to that seen in the outward hypotrophic arteriolar remodeling occurring in the maternal brain, and how preeclampsia may affect this remodeling, remains unclear and requires further investigation.
The cerebral circulation during pregnancy and preeclampsia
2019, Sex Differences in Cardiovascular Physiology and PathophysiologyPre-eclampsia and maternal health through the prism of low-income countries
2023, Journal of Perinatal MedicineStroke Around Pregnancy; Protection and Prevention!
2023, Annals of Indian Academy of Neurology
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Supported by grants from the Swedish Medical Research Council (No. 27X-12276).
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Reprint requests: Helena Salonen Ros, Department of Medical Epidemiology, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden. E-mail: [email protected].