Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis.
OBJECTIVE
The study goal was to identify potential risk factors for peripartum or postpartum stroke and intracranial venous thrombosis.


METHODS
Data from the Healthcare Cost and Utilization Project were analyzed for the years 1993 and 1994. Observed values were weighted with poststratification discharge weights to project to the universe of all discharges from community hospitals located in the United States. Nationally representative estimates of risk were calculated on the basis of age, race, mode of delivery, income, third-party payer, hospital size, hospital ownership, hospital location (rural versus urban), hospital teaching status, census region, and presence of specific complications. Multivariate models were developed with the use of logistic regression.


RESULTS
Among 1 408 015 sampled deliveries, there were 183 observed cases of peripartum stroke and 170 cases of peripartum intracranial venous thrombosis in 17 states in the United States in 1993 and 1994. There were an estimated 975 cases of stroke and 864 cases of intracranial venous thrombosis during pregnancy and the puerperium in the United States among 7 463 712 deliveries during 1993 and 1994, for estimated risks of 13.1 cases of peripartum stroke and 11.6 cases of peripartum intracranial venous thrombosis per 100 000 deliveries. Multivariate analysis showed that the following were strongly and significantly associated with both peripartum and postpartum stroke: cesarean delivery; fluid, electrolyte, and acid-base disorders; and hypertension. Covariates that were strongly and significantly associated with both peripartum and postpartum intracranial venous thrombosis included cesarean delivery, hypertension, and infections other than pneumonia and influenza.


CONCLUSIONS
Pregnancy-related hypertension and cesarean delivery are important risk factors for both stroke or intracranial venous thrombosis.
Lanska
D J
DJ
Department of Veterans Affairs Medical Center, Great Lakes Health Care System, Tomah, WI 54660, USA. Douglas.Lanska@med.va.gov
Kryscio
R J
RJ
D000137:Acid-Base Imbalance / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D002550:Cerebral Veins; D002585:Cesarean Section / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D020767:Intracranial Thrombosis / Q000453:epidemiology*; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D011254:Pregnancy in Diabetics / Q000453:epidemiology; D011644:Puerperal Disorders / Q000453:epidemiology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology