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AUSTIN, Texas -- Perinatal arterial ischemic stroke has many possible risk factors, including gestational diabetes, researchers reported here.
Compared with perinatal watershed infarcts and hypoxic ischemic encephalopathy, babies with perinatal arterial ischemic stroke had higher rates of gestational diabetes (P=0.008), methylenetetrahydrofolate reductase (MTHFR) deficiency (P=0.03), and high birthweight (P=0.07), according to , of Inova Children's Hospital in Falls Church, Va., and colleagues.
Action Points
- This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The next step in understanding the origins of perinatal arterial ischemic stroke would involve placenta testing, Lateef and colleagues said at the annual meeting of the Child Neurology Society.
The researchers looked at neuroimaging scans of perinatal stroke patients from 2002 to 2012 at Inova Children's Hospital. They were able to diagnose 10 babies with watershed infarcts, 28 with hypoxic ischemic encephalopathy (HIE), and 18 with perinatal arterial ischemic stroke (PAIS).
Among the PAIS babies, 56% had two or more known risk factors, but 11% had none of the known risk factors for PAIS. The vast majority of PAIS infants -- 89% -- presented at some point in the first week of life, and 67% of them did so with seizures, but the rest showed abnormal tone or reflexes, or had trouble breathing.
Gestational diabetes was more common in PAIS babies, at 33%, compared with 10% of watershed infarct babies, and only 4% of HIE babies. Lateef and colleagues noted that a found gestational diabetes was present in 40% of the PAIS pregnancies they evaluated.
MTHFR enzyme testing revealed that 60% of PAIS babies showed MTHFR deficiency, but none of the watershed infarct or HIE babies had MTHFR deficiency (P=0.03). Lateef and colleagues wrote that it was unclear whether MTHFR deficiency was an independent risk factor for PAIS, or was only a risk factor in combination with other known risk factors.
High birthweight, ≥97th% for age, was found in 22% of PAIS babies, 4% of HIE babies, and 0% of watershed infarct babies. This finding suggests that high birthweight could be a possible risk factor for PAIS, they noted.
Carla Zingariello, DO, who also worked on the study, told ľֱ that since this study did not use a control group, large for gestational age (LGA) could not be considered statistically significant, but that the investigators intend to continue with this research, and that they would use a control group to determine the statistical significance of LGA as a risk factor for PAIS.
The researchers also tested for other pro-blood clot factors, such as lipoprotein A, Factor V Leiden, protein C, antithrombin III, and homocysteine deficiency, but none appeared to be significantly different between groups.
"The placenta has its own clotting mechanisms that may contribute to arterial stroke," Lateef and colleagues wrote. They noted that other studies have found PAIS in babies with high birthweights, and abnormal placental function may be related.
"Even in pregnancies that are high risk, even in deliveries where catastrophic things happen, people do not save the placenta, and, to me, that's just a huge piece of missing evidence. How are we ever going to find the cause of what made this happen if we don't save the evidence?" Lateef told ľֱ.
It [the placenta] is not just this passive organ that transmits nutrients and oxygen. So many times, when you look at the placenta, you find inflammatory disorders, or infarcts, and for years, we were blaming the poor gynecologists for birth asphyxia or the delivery that caused the problem, but no -- the placenta wasn't functioning for months before the baby was born," Lateef continued.
"The two fields [gynecology and obstetrics] don't talk to one another, as gynecologists are most interested in maternal health, and then neonatologists are called in after the fact [birth]," Lateef said.
Zingariello emphasized that the next step in the research should include a study of placentas from PAIS babies for further clues into potential risk factors. "In these risk populations, save the placenta," she recommended.
CORRECTION: This article, which was originally published Nov. 5, 2013, has been corrected. It misstated the name of a researcher who worked on the study. Her name is Carla Zingariello, not Christina Zingariello.
Disclosures
No outside funding sources were used. The authors declared no conflicts of interest.
Primary Source
Child Neurology Society
Lateef T, et al "Risk factors for perinatal stroke" CNS 2013; Abstract 135.