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Neonatal-Perinatal Health Care Delivery: Epidemiology/Health Services Research

Neonatal-Perinatal Health Care Delivery 3: Epi/HSR Antenatal Exposures and Neonatal Outcomes

750 - Overweight and obesity in the mother and risk of perinatal ischemic stroke

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 750
Publication Number: 750.246

Anna Walås, Linkoping University, Linköping, Ostergotlands Lan, Sweden; Eleni Simatou, Karolinska Institute, Stockholm, Stockholms Lan, Sweden; Mikael A. Franko, Karolinska institute, Stockholm, Stockholms Lan, Sweden; Neda Razaz, Karolinska Insitutet, Stockholm, Stockholms Lan, Sweden; Martina Persson, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden; Olof Stephansson, Karolinska Institutet, Visby, Gotlands Lan, Sweden; Heléne E. K.. Sundelin, Karolinska Institutet and University Hospital, Stockholm, Stockholms Lan, Sweden; Jenny Bolk, Karolinska institutet, Stockholm, Stockholms Lan, Sweden

Presenting Author(s)

Anna Walås, MD (she/her/hers)

Resident
Linkoping University
Linköping, Ostergotlands Lan, Sweden

Background: Obesity is a growing problem among pregnant women, increasing the risk of several obstetric and perinatal complications. However, the impact of maternal weight on the risk of perinatal stroke has not been evaluated even though it is one of few preventable possible risk factors.

Objective: We aimed to evaluate maternal overweight and obesity as a risk factor for perinatal ischemic stroke.

Design/Methods: In this nationwide cohort study we included all singleton live births in Sweden January 1 1998 to December 31 2019. Infants diagnosed with major congenital malformations and those with missing data on exposure were excluded. Follow-up was until the 28^th day of life, March 31 2020 or death. Prospectively collected data from Swedish national health registers, including the Swedish neonatal quality register, were linked on the individual level. The exposure maternal body mass index (BMI) was calculated from early pregnancy weight measurements. The outcome of perinatal ischemic stroke was defined as an International Classification of Diseases diagnosis of ischemic stroke in the Swedish national health registers or by the cerebral infarction check-box in the Swedish neonatal quality register. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Analyses were guided by a causal directed acyclic graph. Sensitivity analyses were run for full-term infants, infants diagnosed by international classification of diseases codes, infants born from 2012 and onwards and with imputation for missing data.

Results: Among the 2,288,062 births, 1,951,356 were available for analysis after exclusions. There were 454 infants (238 boys) diagnosed with perinatal ischemic stroke, among which there were 26.2% of mothers with overweight (BMI 25< 30) and 21.1% of mothers with obesity (BMI≥30) compared to the total population where the numbers were 25.7% and 12.4% respectively. The infant’s risk of perinatal ischemic stroke was increased 2-fold in mothers with obesity class I (BMI 30< 35) (adjusted OR (aOR); 95% CI 1.84; CI 1.37 – 2.43) and obesity class ≥II (BMI >35) (aOR 2.01; CI 1.33 – 2.92), but was not increased in mothers with overweight (aOR 1.17; CI 0.93 – 1.46). Neither adjustments (infant’s year of birth, maternal educational status, maternal ethnicity, parity and smoking) nor sensitivity analyses affected the findings.

Conclusion(s): Maternal obesity is associated with an increased risk of perinatal ischemic stroke. This strengthens the importance of preventing obesity in fertile women.