{
    "abstract": "To investigate whether previously reported increasing incidence of pregnancy-associated stroke (PAS) is observed in chart-validated register data in Finland. In an exploratory analysis, we studied risk factors for PAS.\nWe performed a retrospective population-based cohort study and nested case-control study in Finland from 1987 to 2016. The Medical Birth Register (MBR) was linked to the Hospital Discharge Register to identify women with incident stroke (ischemic stroke, cerebral venous thrombosis, intracerebral or subarachnoid hemorrhage) during pregnancy or puerperium. Cases were verified from patient records. Incidence of PAS over the study period in 5-year age groups and pregnancy/postpartum period was calculated per number of deliveries. Three matched controls were selected for each case from MBR to compare risk factors.\nAfter chart review, 29.6% (257 of 868) of cases were PAS. The incidence of PAS was 14.5 (95% confidence interval [CI] 12.8-16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987 to 1991 to 2012 to 2016 (\nPAS incidence is increasing, stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium.\nThis study provides Class III evidence that smoking beyond 12 gestational weeks, migraine, and hypertensive disorders of pregnancy are associated with an increased risk of PAS.",
    "authors": [
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden. liisa.karjalainen@helsinki.fi.",
            "firstname": "Liisa",
            "initials": "L",
            "lastname": "Karjalainen"
        },
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.",
            "firstname": "Minna",
            "initials": "M",
            "lastname": "Tikkanen"
        },
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.",
            "firstname": "Kirsi",
            "initials": "K",
            "lastname": "Rantanen"
        },
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.",
            "firstname": "Karoliina",
            "initials": "K",
            "lastname": "Aarnio"
        },
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.",
            "firstname": "Aino",
            "initials": "A",
            "lastname": "Korhonen"
        },
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.",
            "firstname": "Anna",
            "initials": "A",
            "lastname": "Saaros"
        },
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.",
            "firstname": "Hannele",
            "initials": "H",
            "lastname": "Laivuori"
        },
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.",
            "firstname": "Mika",
            "initials": "M",
            "lastname": "Gissler"
        },
        {
            "affiliation": "From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvink\u00e4\u00e4 Hospital, Helsinki University Hospital, Hyvink\u00e4\u00e4/Helsinki; 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; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.",
            "firstname": "Petra",
            "initials": "P",
            "lastname": "Ij\u00e4s"
        }
    ],
    "conclusions": "PAS incidence is increasing, stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium.",
    "copyrights": "\u00a9 2021 American Academy of Neurology.",
    "doi": "10.1212/WNL.0000000000011990",
    "journal": "Neurology",
    "keywords": [],
    "methods": null,
    "publication_date": "2021-04-09",
    "pubmed_id": "33827961",
    "results": "After chart review, 29.6% (257 of 868) of cases were PAS. The incidence of PAS was 14.5 (95% confidence interval [CI] 12.8-16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987 to 1991 to 2012 to 2016 (",
    "title": "Stroke in Pregnancy and Puerperium: Validated Incidence Trends With Risk Factor Analysis in Finland 1987-2016.",
    "xml": "<Element 'PubmedArticle' at 0x788505991a80>"
}