Risk of Midlife Stroke After Adverse Pregnancy Outcomes: The FinnGen Study

著者: Eliza C. Miller, Anni Kauko, Sarah E. Tom, Hannele Laivuori, Teemu Niiranen, Natalie A. Bello, Aarno Palotie, Mark J. Daly, Bridget Riley-Gills, Howard J. Jacob, Dirk S. Paul, Athena Matakidou, Adam Platt, Heiko Runz, Sally John, George Okafo, Nathan Lawless, Heli Salminen‐Mankonen, Robert M. Plenge, Joseph Maranville, Mark I. McCarthy, Julie Hunkapiller, Margaret G. Ehm, Kirsi Auro, Simonne Longerich, Caroline S. Fox, Anders Mälarstig, K. Klinger, Deepak Raipal, Eric Green, Robert Graham, Robert Yang, Chris O ́Donnell, Tomi P. Mäkelä, Jaakko Kaprio, Petri Virolainen, Antti Hakanen, Terhi Kilpi, Markus Perola, Jukka Partanen, Anne Pitkäranta, Taneli Raivio, Raisa Serpi, Tarja Laitinen, Veli‐Matti Kosma, Jari A. Laukkanen, Marco Hautalahti, Outi Tuovila, Raimo Pakkanen, Jeffrey F. Waring, Bridget Riley‐Gillis, Fedik Rahimov, Ioanna Tachmazidou, Chia-Yen Chen, Heiko Runz, Zhihao Ding, Marc Jung, Shameek Biswas, Rion Pendergrass, Julie Hunkapiller, Margaret G. Ehm, David Pulford, Neha Raghavan, Adriana Huertas‐Vázquez, Jae-Hoon Sul, Anders Mälarstig, Xinli Hu, K. Klinger, Robert Graham, Eric Green, Sahar V. Mozaffari, Dawn Waterworth, Nicole Renaud, Ma ́en Obeidat, Samuli Ripatti, Johanna Schleutker, Markus Perola, Mikko Arvas, Olli Carpén, Reetta Hinttala, Johannes Kettunen, Arto Mannermaa, Katriina Aalto‐Setälä, Mika Kähönen, Jari A. Laukkanen, Johanna Mäkelä, Reetta Kälviäinen, Valtteri Julkunen, Hilkka Soininen, Anne M. Remes, Mikko Hiltunen, Jukka Peltola, Minna Raivio, Pentti J. Tienari, Juha O. Rinne, Roosa Kallionpää, Juulia Partanen, Ali Abbasi, Adam Ziemann, Nizar Smaoui, Anne Lehtonen, Susan Eaton, Heiko Runz, Sanni Lahdenperä, Shameek Biswas, Julie Hunkapiller, Natalie Bowers, Edmond Teng, Rion Pendergrass, Fanli Xu, David Pulford, Kirsi Auro, Laura Addis, John D. Eicher, Qingqin S. Li, Karen He, Ekaterina Khramtsova, Neha Raghavan, Martti Färkkilâ, Jukka Koskela, Sampsa Pikkarainen, Airi Jussila, Katri Kaukinen, Timo Blomster, Mikko Kiviniemi, Markku Voutilainen, Mark J. Daly, Ali Abbasi, Jeffrey F. Waring, Nizar Smaoui, Fedik Rahimov, Anne Lehtonen, Tim Lu, Natalie Bowers, Rion Pendergrass, Linda McCarthy, Amy Hart, Meijian Guan, Jason Miller, Kirsi Kalpala, Melissa Miller, Xinli Hu, Kari K. Eklund, Antti Palomäki, Pia Isomäki, Laura Pirilä, Oili Kaipiainen‐Seppänen, Johanna Huhtakangas, Nina Mars, Ali Abbasi, Jeffrey F. Waring, Fedik Rahimov, Apinya Lertratanakul, Nizar Smaoui, Anne Lehtonen, Marla Hochfeld, Natalie Bowers, Rion Pendergrass, Jorge Esparza Gordillo, Kirsi Auro, Dawn Waterworth, Fabiana Farias, Kirsi Kalpala, Nan Bing, Xinli Hu, Tarja Laitinen, Margit Pelkonen, Paula Kauppi, Hannu Kankaanranta, Terttu Harju, Riitta Lahesmaa, Nizar Smaoui, Glenda Lassi, Susan Eaton, Hubert Chen, Rion Pendergrass, Natalie Bowers, Joanna Betts, Kirsi Auro, Rajashree Mishra, Majd Mouded, Debby Ngo, Felix Vaura, Veikko Salomaa, Kaj Metsärinne, Jenni Aittokallio, Mika Kähönen, Jussi Hernesniemi, Daniel Gordin, Juha Sinisalo, Marja‐Riitta Taskinen, Tiinamaija Tuomi, Timo P. Hiltunen, Jari A. Laukkanen, Amanda Elliott, Mary Pat Reeve, Sanni Ruotsalainen, Benjamin Challis, Dirk S. Paul, Julie Hunkapiller, Natalie Bowers, Rion Pendergrass, Audrey Y. Chu, Kirsi Auro, Dermot F. Reilly, Mike Mendelson, Jaakko Parkkinen, Melissa Miller, Tuomo J Meretoja, Heikki Joensuu, Olli Carpén, Johanna Mattson, Eveliina Salminen, Annika Auranen, Peeter Karihtala, Päivi Auvinen Klaus Elenius, Johanna Schleutker, Esa Pitkänen, Nina Mars, Mark J. Daly, Relja Popovic, Jeffrey F. Waring, Bridget Riley‐Gillis, Anne Lehtonen, Jennifer L. Schutzman, Julie Hunkapiller, Natalie Bowers, Rion Pendergrass, Diptee Kulkarni, Kirsi Auro, Alessandro Porello, Andrey Loboda, Heli Lehtonen, Stefan McDonough, S. Vuoti, Kai Kaarniranta, Joni A. Turunen, Terhi Ollila, Hannu Uusitalo, Juha Karjalainen, Esa Pitkänen, Mengzhen Liu, Heiko Runz, Stephanie Loomis, Erich C. Strauss, Natalie Bowers, Hao Chen, Rion Pendergrass, Kaisa Tasanen, Laura Huilaja, Katariina Hannula‐Jouppi, Teea Salmi, Sirkku Peltonen, Leena Koulu, Nizar Smaoui, Fedik Rahimov, Anne Lehtonen, David F. Choy, Rion Pendergrass, Dawn Waterworth, Kirsi Kalpala, Ying Wu, Pirkko J. Pussinen, Aino Salminen, Tuula Salo, David Rice, Pekka Nieminen, Ulla Palotie, Maria Siponen, Liisa Suominen, Päivi Mäntylä, Ulvi Kahraman Gürsoy, Vuokko Anttonen, Kirsi Sipilä, Rion Pendergrass, Venla Kurra, Laura Kotaniemi‐Talonen, Oskari Heikinheimo, Ilkka Kalliala, Lauri A. Aaltonen, Varpu Jokimaa, Johannes Kettunen, Marja Vääräsmäki, Outi Uimari, Laure Morin‐Papunen, Maarit Niinimäki, Terhi Piltonen, Katja Kivinen, Elisabeth Widén, Taru Tukiainen, Mary Pat Reeve, Mark Daly, Niko Välimäki, Eija K. Laakkonen, Jaakko Tyrmi, Heidi Silven, Eeva Sliz, Riikka K. Arffman, Susanna Savukoski, Triin Laisk, Natalia Pujol, Mengzhen Liu, Bridget Riley‐Gillis, Rion Pendergrass, Janet Kumar, Kirsi Auro, Iiris Hovatta, Chia-Yen Chen, Erkki Isometsä, Hanna M. Ollila, Jaana Suvisaari, Thomas D. Als, Antti Mäkitie, Argyro Bizaki-Vallaskangas, Sanna Toppila‐Salmi, Tytti Willberg, Elmo Saarentaus, Antti A. Aarnisalo, Eveliina Salminen, Elisa Rahikkala, Johannes Kettunen, Kristiina Aittomäki, Fredrik Åberg, Mitja Kurki, Samuli Ripatti, Mark J. Daly, Juha Karjalainen, Aki S. Havulinna, Juha Mehtonen, Priit Palta, Shabbeer Hassan, Pietro Della, Briotta Parolo, Wei Zhou, Mutaamba Maasha, Shabbeer Hassan, Susanna Lemmelä, Manuel A. Rivas, Mari Niemi, Aarno Palotie, Aoxing Liu, Arto Lehistö, Andrea Ganna, Vincent Llorens, Taru Tukiainen, Mary Pat Reeve, Henrike Heyne, Nina Mars, Joel Rämö, Elmo Saarentaus, Hanna M. Ollila, Rodos Rodosthenous, Satu Strausz, Tuula Palotie, Kimmo Palin, Javier Gracia‐Tabuenca, Harri Siirtola, Tuomo Kiiskinen, Jiwoo Lee, Kristin Tsuo, Amanda Elliott, Kati Kristiansson, Mikko Arvas, Kati Hyvärinen, Jarmo Ritari, Olli Carpén, Johannes Kettunen, Katri Pylkäs, Eeva Sliz, Minna K. Karjalainen, Tuomo Mantere, Eeva Kangasniemi, Sami Heikkinen, Arto Mannermaa, Eija K. Laakkonen, Nina Pitkänen, Samuel Lessard, Clément Chatelain, Perttu Terho, Sirpa Soini, Jukka Partanen, Eero Punkka, Raisa Serpi, Sanna Siltanen, Veli‐Matti Kosma, Teijo Kuopio, Anu Jalanko, Huei-Yi Shen, Risto Kajanne, Mervi Aavikko, Henna Palin, Malla-Maria Linna, Mitja Kurki, Juha Karjalainen, Pietro Della, Briotta Parolo, Arto Lehistö, Juha Mehtonen, Wei Zhou, Masahiro Kanai, Mutaamba Maasha, Aki S. Havulinna, Susanna Lemmelä, Tuomo Kiiskinen, L. Elisa Lahtela, Mari Kaunisto, Elina Kilpeläinen, Timo P. Sipilä, Oluwaseun Alexander Dada, Awaisa Ghazal, Anastasia Kytölä, Rigbe Weldatsadik, Sanni Ruotsalainen, Kati Donner, Timo P. Sipilä, Anu Loukola, Päivi Laiho, Tuuli Sistonen, Essi Kaiharju, Markku Laukkanen, Elina Järvensivu, Sini Lähteenmäki, Lotta Männikkö, Regis Wong, Auli Toivola, Minna Brunfeldt, Hannele Mattsson, Kati Kristiansson, Susanna Lemmelä, Sami Koskelainen, Tero Hiekkalinna, Teemu Paajanen, Priit Palta, Kalle Pärn, Mart Kals, Shuang Luo, Tarja Laitinen, Mary Pat Reeve, Shanmukha Sampath Padmanabhuni, Marianna Niemi, Harri Siirtola, Javier Gracia‐Tabuenca, Mika Helminen, Tiina Luukkaala, Iida Vähätalo, Jyrki Pitkänen, Marco Hautalahti, Johanna Mäkelä, Sarah Smith, Tom Southerington - Stroke 2023 被引用: 27

BACKGROUND: Adverse pregnancy outcomes (APO) contribute to higher risk of maternal cerebrovascular disease, but longitudinal data that include APO and stroke timing are lacking. We hypothesized that APO are associated with younger age at first stroke, with a stronger relationship in those with >1 pregnancy with APO. METHODS: We analyzed longitudinal Finnish nationwide health registry data from the FinnGen Study. We included women who gave birth after 1969 when the hospital discharge registry was established. We defined APO as a pregnancy affected by gestational hypertension, preeclampsia, eclampsia, preterm birth, small for gestational age infant, or placental abruption. We defined stroke as first hospital admission for ischemic stroke or nontraumatic intracerebral or subarachnoid hemorrhage, excluding stroke during pregnancy or within 1 year postpartum. We used Kaplan-Meier survival curves and multivariable-adjusted Cox and generalized linear models to assess the relationship between APO and future stroke. RESULTS: We included 144 306 women with a total of 316 789 births in the analysis sample, of whom 17.9% had at least 1 pregnancy with an APO and 2.9% experienced an APO in ≥2 pregnancies. Women with APO had more comorbidities including obesity, hypertension, heart disease, and migraine. Median age at first stroke was 58.3 years in those with no APO, 54.8 years in those with 1 APO, and 51.6 years in those with recurrent APO. In models adjusted for sociodemographic characteristics and stroke risk factors, risk of stroke was greater in women with 1 APO (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.4]) and recurrent APO (adjusted hazard ratio, 1.4 [95% CI, 1.2-1.7]) compared with those with no APO. Women with recurrent APO had more than twice the stroke risk before age 45 (adjusted odds ratio, 2.1 [95% CI, 1.5-3.1]) compared with those without APO. CONCLUSIONS: Women who experience APO have earlier onset of cerebrovascular disease, with the earliest onset in those with more than 1 affected pregnancy.