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Infections a risk factor for PAS in women with pre-eclampsia

25 Jul 2017

The risk of pregnancy-associated stroke (PAS) among women with pre-eclampsia appears to increase with the presence of infections, chronic hypertension, coagulopathies and underlying prothrombotic conditions, a study has shown.

Using billing data from the 2003 to 2012 New York State Department of Health inpatient database, researchers identified 88,857 women aged 12 to 55 years who had pre-eclampsia. The women were assessed for predefined PAS risk factors including pregnancy complications, infection present on admission, vascular risk factors, prothrombotic states and coagulopathies.

Of the women with pre-eclampsia, 197 had PAS, yielding a cumulative PAS incidence of 222 per 100,000 person-years during the study period.

In multivariable conditional logistic regression models, pre-eclamptic women with PAS were more likely to have severe pre-eclampsia or eclampsia (odds ratio [OR], 7.2; 95 percent CI, 4.6 to 11.3), infections presented on admission (OR, 3.0; 1.6 to 5.8), prothrombotic states (OR, 3.5; 1.3 to 9.2), coagulopathies (OR, 3.1; 1.3 to 7.1) or chronic hypertension (OR, 3.2; 1.8 to 5.5) compared with pre-eclamptic women without PAS.

The results were confirmed in a subgroup analysis matched and stratified by severity of pre-eclampsia.

A multisystem hypertensive disorder unique to pregnancy, pre-eclampsia is characterized by widespread endothelial dysfunction and immune dysregulation. Pre-eclampsia comorbidity occurs in approximately 36 percent of women with PAS, with the pregnancy disorder increasing stroke risk during the puerperium by up to sixfold. Among women with PAS, those with pre-eclampsia are at higher risk of complications and death. [Curr Opin Obstet Gynecol 2013;25:425–432; Am J Obstet Gynecol 2002;186:198–203; Obstet Gynecol 2015;125:124–131; Eur J Obstet Gynecol Reprod Biol 2013;171:266–270]

Findings of the present study suggest that infections may be an important treatable risk factor in the population of women with PAS and pre-eclampsia, and that screening for coagulopathies and prothrombotic conditions may be warranted in those with pre-eclampsia, researchers said.

Prospective studies are needed to confirm the present data and develop interventions aimed at preventing strokes in this population, they added.

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