Risk factors for perinatal arterial ischaemic stroke: a large case-control study

Area of Science:

• Neonatal neurology
• Perinatal medicine
• Obstetrics

Background:

• Perinatal arterial ischaemic stroke (PAIS) is a significant cause of neonatal brain injury.
• Identifying risk factors is crucial for understanding PAIS pathophysiology and prevention.

Purpose of the Study:

• To identify maternal, obstetric, and neonatal risk factors for PAIS.
• To elucidate the underlying pathophysiology of PAIS.

Main Methods:

• Case-control study using active surveillance in 345 pediatric hospitals.
• Analysis of 134 PAIS cases and 576 controls.
• Multivariate logistic regression guided by a directed acyclic graph.

Main Results:

• Independent risk factors for PAIS included male sex, multiple birth, chorioamnionitis, preterm birth, and small for gestational age (SGA).
• Chorioamnionitis (OR 9.89) and SGA (OR 3.05) demonstrated strong associations with PAIS.
• Male sex (OR 1.81), multiple birth (OR 3.22), and preterm birth (OR 1.86) were also significant risk factors.

Conclusions:

• Chorioamnionitis and SGA are significant independent risk factors for PAIS, suggesting inflammatory processes and fetal-placental insufficiency as key mechanisms.
• Multiple birth and preterm birth are additional important risk factors for PAIS.
• Findings emphasize the need for monitoring and intervention in pregnancies with these risk factors.