Delivery infections contribute to increased postpartum ischaemic stroke risk
Women who develop infection during delivery hospitalization are at higher risk of being readmitted for ischaemic stroke (IS) within 30 days postpartum, especially those with no hypertensive disorders of pregnancy, a study reports.
Researchers drew data from the Healthcare Cost and Utilization Project’s National Readmissions Database from 2010 to 2014. They looked at 17.2 million delivery admissions during the study period and identified 2,128 women readmitted within 30 days (median time to readmission, 6.7 days) for a stroke of any type. Of these women, 1,189 had haemorrhagic stroke (HS; intracerebral haemorrhage or subarachnoid haemorrhage), 720 had IS, and the remainder had unspecified pregnancy-related stroke.
During the initial delivery hospitalization, ≥1 infections developed in 876,633 women (5.1 percent) who did not go on to have a postpartum stroke and in 154 (7.3 percent) of the 2,128 women who were readmitted within 30 days for stroke.
On multivariate Poisson regression analysis, women with delivery infections were at higher risk of readmission for postpartum stroke of any type (adjusted risk ratio [aRR], 1.19, 95 percent CI, 1.01–1.41) and postpartum IS (aRR, 1.75, 1.37–2.22) but not for postpartum HS (aRR, 0.96, 0.75–1.23).
The effect of infection on 30-day postpartum IS readmission was more pronounced in women without hypertensive disorders of pregnancy than in those who had them (aRR, 2.0, 1.55–2.69 vs 1.47, 0.9–2.38; p-interaction=0.09).
According to the researchers, infection may play a role in triggering postpartum IS even in the absence of other risk factors. As such, women with infections during delivery admissions should be counselled on signs and symptoms of stroke and should submit to closer postpartum follow-up.