Maternal and infant characteristics associated with perinatal arterial stroke in the infant
2005
ContextPerinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic
cerebral palsy. Risk factors for this condition have not been clearly defined.ObjectiveTo determine maternal and infant characteristics associated with PAS.Design, Setting, and PatientsCase-control study nested within the cohort of all 199 176 infants
born from 1997 through 2002 in the Kaiser Permanente Medical Care Program,
a managed care organization providing care for more than 3 million residents
of northern California. Case patients were confirmed by review of brain imaging
and medical records (n = 40). Three controls per case were randomly
selected from the study population.Main Outcome MeasureAssociation of maternal and infant complications with risk of PAS.ResultsThe population prevalence of PAS was 20 per 100 000 live births.
The majority (85%) of infants with PAS were delivered at term. The following
prepartum and intrapartum factors were more common among case than control
infants: primiparity (73% vs 44%, P = .002),
fetal heart rate abnormality (46% vs 14%, P<.001),
emergency cesarean delivery (35% vs 13%, P = .002),
chorioamnionitis (27% vs 11%, P = .03),
prolonged rupture of membranes (26% vs 7%, P = .002),
prolonged second stage of labor (25% vs 4%, P<.001),
vacuum extraction (24% vs 11%, P = .04),
cord abnormality (22% vs 6%, P = .01),
preeclampsia (19% vs 5%, P = .01), and
oligohydramnios (14% vs 3%, P = .01). Risk
factors independently associated with PAS on multivariate analysis were history
of infertility (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.3-45.0),
preeclampsia (OR, 5.3; 95% CI, 1.3-22.0), prolonged rupture of membranes (OR,
3.8; 95% CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95% CI, 1.1-10.5).
The rate of PAS increased dramatically when multiple risk factors were present.ConclusionsPerinatal arterial ischemic stroke in infants is associated with several
independent maternal risk factors. How these complications, along with their
potential effects on the placenta and fetus, may play a role in causing perinatal
stroke deserves further study.
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