Maternal obesity associated with increased risk of perinatal ischemic stroke

1. There is a dose-response relationship between maternal body mass index (BMI) and perinatal ischemic stroke (PIS) risk

Evidence Rating Level: 2 (Good) 

This nationwide cohort study investigated the association between maternal early pregnancy body mass index (BMI) and the risk of perinatal ischemic stroke (PIS) in infants. Perinatal ischemic stroke, occurring from 20 weeks’ gestation to 28 days post-birth, affects approximately 1 in 3,000 term-born infants and is associated with significant neurodevelopmental consequences. Given the rising prevalence of maternal obesity and its link to obstetric complications, this study aimed to clarify whether maternal overweight and obesity increase the risk of PIS. The study included 2,140,852 singleton births in Sweden from 1998 to 2019, with 415 infants diagnosed with PIS. Maternal BMI was categorized per WHO criteria: normal weight (18.5–24.9), overweight (25–29.9), and obesity classes I (30–34.9), II (35–39.9), and III (≥40). Adjusted rate ratios (aRRs) for PIS were calculated using Poisson log-linear regression. There was a dose-response relationship between maternal BMI and PIS risk. Compared to infants of normal-weight mothers (19/100,000 births), PIS rates rose to 22/100,000 for overweight mothers, 35/100,000 for obesity class II, and 40/100,000 for class III. The aRRs for PIS were 1.16 (95% CI 0.91–1.46) for overweight, 1.82 (95% CI 1.34–2.44) for obesity class I, and 1.96 (95% CI 1.27–2.91) for obesity classes II-III. These findings suggest maternal obesity is an independent risk factor for PIS, increasing risk nearly twofold in severe obesity. The study demonstrates the importance of maternal weight management and highlights the need for targeted prenatal care strategies to mitigate PIS risk. Further research should explore underlying mechanisms, including placental dysfunction and inflammation.

Click to read the study in Neurology

Image: PD

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