Stroke during pregnancy and the postpartum period: A nationwide population-based study in South Korea

초록

Background: Pregnancy-associated stroke (PAS) is a rare but clinically important complication of pregnancy. Despite its clinical significance, nationwide data on PAS are lacking in South Korea, a representative country with advanced maternal age.Aims: This study aimed to investigate the incidence, temporal trends, and risk factors of PAS in South Korea.Methods: We retrospectively analyzed nationwide data from the Korean National Health Insurance Service (NHIS) to identify women of reproductive age (15-49 years) who delivered between 2014 and 2021. PAS was defined as an ischemic or hemorrhagic stroke occurring during pregnancy or within 6 weeks postpartum. Multivariable logistic regression analysis was performed to identify independent predictors of PAS.Results: Of 2,000,110 deliveries between 2014 and 2021, 909 first-ever strokes occurred during pregnancy or within 6 weeks postpartum, including 500 ischemic (55%) and 409 hemorrhagic (45%) strokes. The overall incidence of PAS was 45.6 per 100,000 deliveries (95% confidence interval (CI), 42.7-48.6) and increased from 41.5 in 2014 to 51.0 in 2021 (p = 0.049), mainly driven by ischemic stroke. PAS occurred predominantly during the postpartum period (p < 0.0001) and among older women (p for trend < 0.0001). In multivariable analysis, advanced maternal age (odds ratio [OR] per year, 1.02; 95% CI, 1.01-1.05), hypertension (OR, 2.04; 95% CI, 1.37-3.04), migraine (OR, 1.33; 95% CI, 1.02-1.74), gestational hypertension (OR, 1.49; 95% CI, 1.04-2.12), pre-eclampsia/eclampsia (OR, 5.00; 95% CI, 3.59-6.96), and peripartum cardiomyopathy (OR, 14.26; 95% CI, 4.48-45.42) were identified as independent predictors of PAS.Conclusion: The incidence of PAS is increasing in South Korea, with advanced maternal age, vascular risk factors, and pregnancy-related complications serving as independent predictors. These findings emphasize the importance of clinical awareness and the identification of women at high risk of PAS.

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