OP75 A systematic review and meta-analysis of risk factors for pregnancy-associated stroke
Notice bibliographique
Résumé
Background Stroke in younger women is rare, however, pregnant women have a significantly increased risk around delivery and in early postpartum. Despite known risk factors, such as high blood pressure, the contribution of female-specific factors to women’s stroke risk are poorly understood. Whilst there are pathophysiological reasons for increased stroke in pregnancy, it is of clinical and public health importance to determine the extent to which these strokes can be pre-identified by background risk and pregnancy-related factors. We conducted a systematic review to identify risk factors for pregnancy-associated stroke; this included risk factors pre-existing (to pregnancy) and those developing during pregnancy and labour. Methods An electronic search of PubMed, MEDLINE and EMBASE databases, without language, study design or publication date restrictions, was performed in November 2018. Study inclusion criteria were reported risk factors/characteristics for women with stroke during pregnancy or up to 12 months after delivery and for a comparison group of pregnant/postpartum women without stroke. Stroke timing (antenatal, perinatal, postnatal), diagnostic type and fatality were assessed. Data were extracted and, where possible, a random effects meta-analysis was conducted, heterogeneity quantified using I2. Methodological quality was assessed using an adapted Newcastle-Ottawa scale. Results Of 3784 papers screened, 9 studies met the inclusion criteria comprising 11,398 women with stroke and >85 million comparison women across 4 countries. Eight studies reported effect measures for at least one risk factor. Of fourteen risk factors reported, 8 showed a statistically significant increase in pregnancy-associated stroke; pooled odds ratios with 95% confidence intervals: maternal age 3;35 years 2.66 (1.83–3.87), black ethnicity 1.56 (1.35–1.81), smoking 1.96 (1.64–2.34), alcohol use 2.32 (1.41–3.81), drug abuse 1.82 (1.19–2.77), hypertension 4.80 (3.26–7.06), pre-eclampsia 10.30 (8.26–12.84) and cesarean delivery 4.85 (2.22–10.59). Parity, body mass index, obesity, diabetes, infection, and migraine were not associated. Studies provided limited data to assess risk factors according to stroke timing, type and fatality. Conclusion Our findings improve current understanding of the relative contributions of different risk factors for pregnancy-associated stroke. However, our work highlights the very few existing studies in this area. The available studies assessed a limited number of risk factors, and many were similar to those known to increase stroke regardless of pregnancy. Studies including detailed risk assessment in relation to pregnancy, delivery and postpartum complications as well as women’s background risks are needed. Additionally, future research should establish whether risk factors differ according to stroke type and time-period in relation to pregnancy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,036 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,018 | 0,030 |
| Bibliométrie | 0,007 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».