Pregnancy outcomes for women with a history of stroke: A population‐based record linkage study

Abstract

Background Little is known about the pregnancy outcomes of women who have had a stroke prior to a first pregnancy. Aim To identify a cohort of primiparous women giving birth to a single baby and compare the pregnancy outcomes of those with a pre‐pregnancy stroke hospitalisation record to those without a stroke hospitalisation record. Materials and Methods Record linkage study of all primiparous women aged 15–44 years with singleton pregnancies birthing in New South Wales, Australia from 2003 to 2015. Stroke was identified from 2001 to 2015 hospital data using International Classification of Diseases tenth Edition – Australian Modification codes I60–64. Women whose first hospital record of stroke was during pregnancy or <42 days after birth were excluded. Outcomes included diabetes or hypertension during pregnancy, mode of delivery, haemorrhage, severe maternal morbidity (validated composite outcome indicator), gestational age at birth, Apgar score (1 min < 7), and small‐for‐gestational age. Results Of 487 767 women with a first pregnancy, 124 (2.5/10 000) had a hospital record which included a pre‐pregnancy stroke diagnosis. Women with a stroke history were more likely to have an early‐term delivery (37–38 weeks; relative risk (RR) 1.49, 95% CI 1.17–1.90) and a pre‐labour caesarean (RR 2.83, 95% CI 2.20–3.63). There were no significant differences in other maternal or neonatal outcomes. Conclusion This is the largest reported study of pregnancy and birth outcomes for women with a history of stroke. With the exception of pre‐labour caesarean, there were no differences in pregnancy outcomes for women with a history of stroke compared with women with no history of stroke.

A scoping review of maternal near miss assessment in Australia, New Zealand, South‐East Asia and the South Pacific region: How, what, why and where to?

“…In contrast, most high‐income settings data relating to MNM have been attained from routinely collected data sets with the majority undertaken retrospectively – the admission to high dependency unit/ICU and MMOI criteria were used most often in NZ and Australia, respectively 28–43 . These studies assessed the level of severe morbidity either as a composite indicator or associated with a particular condition and/or to determine risk factors associated with severe morbidity using routinely collected datasets, with large sample sizes retrospectively correlated to ICD‐10 codes.…”

“…In contrast, most high-income settings data relating to MNM have been attained from routinely collected data sets with the majority undertaken retrospectively -the admission to high dependency unit/ICU and MMOI criteria were used most often in NZ and Australia, respectively. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] These studies assessed the level of severe morbidity either as a composite indicator or associated with a particular condition and/or to determine risk factors associated with severe morbidity using routinely collected datasets, with large sample sizes retrospectively correlated to ICD-10 codes. Besides the MMOI, other ICD-based criteria included the modified Wahlberg et al 22 criteria, a Centre for Disease Control (CDC) SMM tool 44 and a modified combination of the WHO plus American College of Obstetricians and Gynecologists diagnostic and intervention codes.…”

“…21,22,27,32,39,43,[54][55][56] Among these studies, non-European ethnicity, low socio-economic status, and clinical factors such as older age, previous pregnancy, or medical complications were identified. Other near miss studies either did not focus on risk factor determination, eg studies on preventability of severe morbidity reviewed risk factors specific to the disease condition of focus (eg women with juvenile arthritis [34][35][36]38 or reported on demographics but did not undertake statistical analysis due to the small numbers identified. 52,[57][58][59][60]…”

Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis

“…With regards to women with previous stroke, our results are in agreement with previous population-based literature from other countries that found these women were more likely to deliver preterm and have a history of hypertensive disorders. 24,29 We add 2 new findings that women with previous stroke also more frequently experienced fetal stress during delivery and received maternal care for known or suspected poor intrauterine growth. To our surprise, they were less likely to have codes for labor and delivery complications.…”

“…We identified clinical and obstetric factors associated with increased maternal morbidity and mortality from previous studies. 2,[13][14][15][16][17][18][19][20][21][22][23][24] Obstetric characteristics of interest included the validated CDC SMM indicators. 2,13,14,18,25 The 21 SMM indicators include serious labor and delivery outcomes that are identifiable at delivery hospitalization using ICD-10 procedure and diagnosis codes and provide a standardized tool to track acute peripartum complications that may result in significant short-or long-term maternal health sequelae (e.g., cardiac arrest, eclampsia, sepsis).…”