{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T19:19:39Z","timestamp":1793992779220,"version":"4.8.0"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T00:00:00Z","timestamp":1691712000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Intracerebral hemorrhage during pregnancy or puerperium (pICH) is one of the leading causes of maternal death worldwide. However, limited epidemiological data exist on the etiology and outcomes of pICH, which is required to guide prevention and treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective nationwide cohort study and a nested case\u2013control study was performed in Finland 1987\u20132016. We identified women with incident pICH by linking the Medical Birth Register (MBR) and the Hospital Discharge Register (HDR). The clinical details were collected from patient records. Three matched controls with a pregnancy without ICH were selected for each case from the MBR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 49 pICH cases were identified. Half of these cases occurred during pregnancy, and the other half during peripartum and puerperium. Based on the SMASH\u2010U (structural vascular lesion, medication, amyloid angiopathy, systemic disease, hypertension, undetermined) classification, 35.4% of the patients had a systemic disease, most commonly preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome; 31.3% had a structural vascular lesion; 31.3% had an undetermined etiology; and one patient (2.1%) had hypertension. The most important risk factor was hypertensive disorders of pregnancy (HDP; odds ratio\u2009=\u20093.83, 95% confidence interval\u2009=\u20091.60\u20139.15), occurring in 31% of the cases. Maternal mortality was 12.5%, and 20.9% of the surviving women had significant disability (modified Rankin Scale\u2009=\u20093\u20135) 3\u2009months after the pICH. Women with systemic disease had the worst outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Even in a country with a comprehensive pregnancy surveillance system, the maternal mortality rate for pICH is high, and the sequelae are severe. Early recognition and treatment of the key risk factor, HDP, is crucial to help prevent this serious pregnancy complication.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16012","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T02:39:26Z","timestamp":1691030366000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Etiology of intracerebral hemorrhage during pregnancy or puerperium: A nationwide study"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0698-4824","authenticated-orcid":false,"given":"Teresa","family":"Vest","sequence":"first","affiliation":[{"name":"Department of Neurology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsi","family":"Rantanen","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5261-3971","authenticated-orcid":false,"given":"Liisa","family":"Verho","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karoliina","family":"Aarnio","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aino","family":"Korhonen","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Richardt","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-2344","authenticated-orcid":false,"given":"Daniel","family":"Strbian","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8254-7525","authenticated-orcid":false,"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Department of Knowledge Brokers Finnish Institute for Health and Welfare  Helsinki Finland"},{"name":"Department of Molecular Medicine and Surgery Karolinska Institutet  Stockholm Sweden"},{"name":"Region Stockholm Academic Primary Health Care Centre  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3212-7826","authenticated-orcid":false,"given":"Hannele","family":"Laivuori","sequence":"additional","affiliation":[{"name":"Medical and Clinical Genetics University of Helsinki and Helsinki University Hospital  Helsinki Finland"},{"name":"Institute for Molecular Medicine Finland, Helsinki Institute of Life Science University of Helsinki  Helsinki Finland"},{"name":"Department of Obstetrics and Gynecology Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research Tampere  Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5493-8588","authenticated-orcid":false,"given":"Minna","family":"Tikkanen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7292-1971","authenticated-orcid":false,"given":"Petra","family":"Ij\u00e4s","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.118.11513"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13172"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.2769"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000011990"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03259.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-020-0390-z"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000228277.84760.a2"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep09509"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000080354"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.31.12.2948"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.112.661603"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(07)61602-x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2016.11.021"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.117.017866"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000003891"},{"key":"e_1_2_11_17_1","unstructured":"Hypertension and preeclampsia during pregnancy. Helsinki: the Finnish medical society Duodecim. December 2 2021. Accessed: July 11 2023.https:\/\/www.kaypahoito.fi\/hoi50128"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1747493017723271"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.108.540880"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12336"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.26.6.930"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.116.014406"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.7461\/jcen.2022.E2022.05.001"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h5762"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.04.026"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.16012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T09:45:37Z","timestamp":1710755137000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.16012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,11]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/ene.16012"],"URL":"https:\/\/doi.org\/10.1111\/ene.16012","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,11]]},"assertion":[{"value":"2023-05-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e16012"}}