Preterm Delivery and Long-Term Risk of Stroke in Women: A National Cohort and Cosibling Study.
Preterm Delivery and Long-Term Risk of Stroke in Women: A National Cohort and Cosibling Study.
复制标题
DOI：
10.1161/circulationaha.120.052268
复制
发表时间：
2021-05-25
期刊：
影响因子：
37.8
通讯作者：
Sundquist K
中科院分区：
文献类型：
--
作者：
Crump C;Sundquist J;Sundquist K
Stroke has a high burden of disease in women, and adverse pregnancy outcomes have been identified as important risk factors for stroke later in life. However, long-term risks of stroke associated with preterm delivery, and whether such risks are due to familial confounding, are unclear. Such knowledge is needed to improve long-term risk assessment and stroke prevention in women. A national cohort study was conducted of all 2,188,043 women with a singleton delivery in Sweden in 1973-2015, who were followed up for stroke identified from nationwide diagnoses through 2015. Cox regression was used to compute adjusted hazard ratios (aHRs) for stroke associated with pregnancy duration, and co-sibling analyses assessed for confounding by shared familial (genetic and/or environmental) factors. In 48.0 million person-years of follow-up, 36,372 (1.7%) women were diagnosed with stroke. In the 10 years following delivery, the aHR for stroke associated with preterm delivery (gestational age <37 weeks) was 1.61 (95% CI, 1.45-1.79), and further stratified was 2.81 (2.02-3.91) for extremely preterm (22-27 weeks), 2.07 (1.74-2.46) for very preterm (28-33 weeks), 1.38 (1.21-1.57) for late preterm (34-36 weeks), and 1.15 (1.06-1.24) for early term (37-38 weeks), compared with full-term (39-41 weeks). These risks remained similarly elevated at 10-19 years after delivery (preterm vs. full-term: aHR, 1.61; 95% CI, 1.50-1.74), then declined but remained significantly elevated at 20-29 years (1.35; 1.28-1.44) and 30-43 years (1.35; 1.27-1.42). Preterm delivery was associated with both hemorrhagic (aHR, 1.31; 95% CI, 1.25-1.38) and ischemic (1.54; 1.47-1.61) stroke across the entire follow-up period (up to 43 years). These findings were not explained by shared determinants of preterm delivery and stroke within families. Stroke risks were higher after either spontaneous or medically indicated preterm delivery, and recurrent preterm delivery was associated with further increases in risk. In this large national cohort, preterm delivery was associated with higher future risks of both hemorrhagic and ischemic stroke. These associations remained substantially elevated at least 40 years later, and were largely independent of covariates and shared familial factors. Preterm delivery should be recognized as a risk factor for stroke in women across the life course.
