Risk Factors for Pregnancy-Associated Stroke in Women with Preeclampsia: a Case-Control Study (S15.007)

Objective: To determine modifiable risk factors for pregnancy-associated stroke (PAS) in women with preeclampsia (PEC). Background: PEC affects 5–8% of pregnancies, and increases risk of PAS. Data are limited on which women with PEC are at highest risk for PAS. Design/Methods: We conducted a retrospective case-control study of women with PEC using billing data from the 2003–2012 New York State Department of Health inpatient database. Women with PEC and PAS were considered cases; cases were matched 1:3 to preeclamptic controls on age, race/ethnicity, and disease severity (mild PEC, or severe PEC including eclampsia). Pre-defined risk factors included pregnancy complications, infection present on admission, chronic hypertension, heart disease, diabetes, and preexisting prothrombotic states. We described stroke types, timing and in-hospital mortality and constructed multivariable conditional logistic regression models to calculate the odds ratios and 95% confidence intervals (OR, 95%CI) for independent stroke risk factors. Results: Among women aged 12–55 years admitted during the study period (n= 3,373,114), 88,859 had PEC, 197 of whom (0.2%) had PAS. Among cases, 182 of 197 strokes (92.4%) occurred during the delivery admission or post partum following discharge, and 97 of 197 (49.2%) were hemorrhagic. In multivariate analysis, cases were more likely than controls to have preexisting hypertension (OR 4.1, 95%CI 2.4–7.3), underlying prothrombotic conditions (OR 3.6, 95%CI 1.9–6.8), and infections present on admission (OR 2.3, 95%CI 1.3–4.1). Cases were less likely to be in their second or subsequent pregnancy (OR 0.6, 95%CI 0.4–0.9) and less likely to have twin or other multiple pregnancy (OR 0.2, 95%CI 0.1–0.6). Mortality was 13.2% among cases (26 of 197), versus 0.1% (1 of 591) among controls (p Conclusions: Chronic hypertension, underlying prothrombotic conditions and infections increase PAS risk in women with PEC. These women may warrant closer postpartum monitoring, due to high PAS-associated mortality in this population. Disclosure: Dr. Miller has nothing to disclose. Dr. Gatollari has nothing to disclose. Dr. Too has nothing to disclose. Dr. Boehme has nothing to disclose. Dr. Leffert has nothing to disclose. Dr. Elkind has received personal compensation in an editorial capacity for Neurology. Dr. Willey has received personal compensation for activities with Heartware Incoporated as a consultant, from Claret Medical and Reliant Heart as a clinical trial endpoint committee member, and from Up-to-Date as a topic reviewer, Dr. Willey has received personal compensation in an editorial capacity for the the American College of Physicians. Dr. Willey has received research support from Genentech and Astra-Zeneca as a clinical trial local principal investigator.