Introduction
Pre-eclampsia/eclampsia, a hypertensive disorder of pregnancy, is a serious and common obstetric complication1. The incidence of pre-eclampsia/eclampsia in pregnant women is 5-8% worldwide, and it is a major cause of maternal morbidity and mortality2-4. Pre-eclampsia/eclampsia is defined as hypertension with high levels of protein in their urine (i.e. proteinuria) after 20 weeks of gestation. Severe pre-eclampsia/eclampsia is a serious threat to the lives of mothers and fetuses, leading to cardiovascular and metabolic complications for mothers and persistent bradycardia, hypotension, and neonatal hypoglycemia for fetuses5-7. Pre-eclampsia/eclampsia may lead to serious kidney, brain, and blood clotting problems which cause 10-15% of maternal deaths in lower-income countries8,9.
Among these different sequelae of pre-eclampsia/eclampsia, stroke is a serious one. The incidence of stroke10-13, both ischemic and hemorrhagic subtypes14,15, increased in the peripartum and postpartum stages. Stroke is an important issue not only in the elderly, but also in pregnant women. Stroke incidence ranges from 1.5 to 34.2 per 100,000 deliveries in pregnancy and the puerperium16,17. It has been reported that pre-eclampsia/eclampsia-related stroke would cause direct obstetric death18,19. The incidence of stroke in pregnant women in previous studies is varied according to different preexisting risk factors16,20.
It has been reported that the probability of cardiovascular7 and cerebrovascular disease10,21in the next few years after childbirth in women with ever pre-eclampsia/eclampsia would to be higher than that in the general population. However, long-term impact of pre-eclampsia/eclampsia on cerebrovascular disease is unknown.
In this study, we aimed to utilize a nationwide database to explore the long-term overall, ischemic, and hemorrhagic stroke risks in women with a history of pre-eclampsia/eclampsia, after decades follow up.