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Long-Term Mortality, Recovery, and Vocational Status After a Maternal Stroke: Register-Based Observational
Liisa Verho1, Karoliina Aarnio1, Minna Tikkanen1
1From the Department of Neurology (L.V., K.A., K.R., A.K., A.R., P.I.); Department of Obstetrics and Gynecology (L.V., O.Ä.), University of Helsinki and Helsinki University Hospital; Department of Obstetrics and Gynecology (M.T.), University of Helsinki; Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research; Department of Knowledge Brokers (M.G.), Finnish Institute for Health and Welfare, Finland; and Region Stockholm (M.G.), Academic Primary Health Care Centre, Stockholm, Sweden and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Background And Objectives:
Maternal stroke is a rare event with an increasing incidence. Data on the long-term prognosis after a maternal stroke are limited. We aimed to examine long-term mortality, recovery, vocational status and morbidity after a maternal stroke in a population-based setting including a comparison with matched, stroke-free controls.
Methods:
In this register-based study with hospital chart validation, we included all women with a maternal stroke in Finland in 1987-2016 who survived the first year after the event. The recovery of the cases was assessed from the hospital charts by modified Rankin scale (mRS). Three controls matched by delivery year, age, and parity were selected for each case. All deaths until 2022 were identified from the Register for Causes of Death. Data on vocational status were obtained from Statistics Finland and morbidity from the Hospital Discharge Register and patient charts until year 2016.
Results:
The study included 235 women with a maternal stroke and 694 matched controls. The median follow-up time was 17.5 years (interquartile range [IQR] 9.6-25.4) for mortality and 11.8 years (IQR 3.8-19.8) for vocational status and subsequent morbidity. Mortality among cases was 5.5% and among controls, 2.4% (age-adjusted odds ratio [OR] 2.3, 95% [CI] 1.1-4.9). At the end of the follow-up, 90.3% of the cases were independent in daily activities (mRS ≤2). In 2016, fewer women with a maternal stroke were working compared with controls (65.9% vs 79.1%, OR 0.5, 95% CI 0.4-0.7) and were more often receiving a pension (18.2% vs 4.9%, OR 4.4, 95% CI 2.7-7.3). Cerebrovascular events (age-adjusted OR 8.6 95% CI 4.4-17.1), cardiac diseases (age-adjusted OR 3.3, 95% CI 1.4-7.7), and major cardiovascular events were more common among cases during the follow-up (age-adjusted OR 7.6 95% CI 3.1-18.7).
Discussion:
Despite having higher overall mortality and higher cardiovascular morbidity, the majority of the maternal stroke survivors recovered well. As expected, the vocational status of cases was inferior to that of controls, but most women were working at the end of the follow-up. Our study provides important information on the prognosis and sequalae after a maternal stroke to help in patient counseling and to improve secondary prevention.
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