Context: Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy.Risk factors for this condition have not been clearly defined.Objective: To determine maternal and infant characteristics associated with PAS.Design, Setting, and Patients: Case-control study nested within the cohort of all 199176 infants born from 1997 through 2002 in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California.Case patients were confirmed by review of brain imaging and medical records (n = 40).Three controls per case were randomly selected from the study population.Main Outcome Measure: Association of maternal and infant complications with risk of PAS.Results: The population prevalence of PAS was 20 per 100000 live births.The majority (85%) of infants with PAS were delivered at term.The following prepartum and intrapartum factors were more common among case than control infants: primiparity (73%vs 44%, P=.002), fetal heart rate abnormality (46%vs 14%, P<.001), emergency cesarean delivery (35%vs 13%, P=.002), chorioamnionitis (27%vs 11%, P=.03), prolonged rupture of membranes (26%vs 7%, P=.002), prolonged second stage of labor (25%vs 4%, P<.001), vacuum extraction (24%vs 11%, P=.04) , cord abnormality (22%vs 6%, P=.01), preeclampsia (19%vs 5%, P=.01), and oligohydramnios (14%vs 3%, P=.01).Risk factors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95%confidence interval [CI], 1.3-45.0)-, preeclampsia (OR, 5.3; 95%CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8; 95%CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95%CI, 1.1-10.5).The rate of PAS increased dramatically when multiple risk factors were present.Conclusions: Perinatal arterial ischemic stroke in infants is associated with several independent maternal risk factors.How these complications, along with their potential effects on the placenta and fetus, may play a role in causing perinatal stroke deserves further study.
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