(468) Temporal Trends in Pregnancy Associated Stroke: Risk Factors and Associated Outcomes, A National Cohort

Our aim was to assess the temporal trend and to ascertain whether risks factors or adverse outcomes in the U.S. differed by timing of pregnancy associated stroke (antepartum versus postpartum).


Study Design: The National Inpatient Sample was queried to identify hospitalizations in the U.S. with pregnancy associated stroke (PAS) (ischemic, hemorrhagic, cerebral venous thrombosis, and transient ischemic attack) from January 2016 to December 2019. Temporal trends in pregnancy associated stroke, as well as risk factors were compared as to the timing of stroke- antepartum versus postpartum. Antepartum stroke was defined as any hospitalization with stroke prior to or including labor. Postpartum stroke was defined as hospitalization occurring separate and after delivery hospitalization. Differences between timing of stroke (antepartum versus postpartum) were examined using the student’s t-test for continuous variables and χ²
tests for categorical variables. Rates were expressed per 100,000 hospitalizations.

Results: Among 15,977,644 pregnancy-associated hospitalizations, 6,100 had PAS (38.2 strokes per 100,000 pregnancy hospitalizations). During the study period, rate of PAS increased by 8.8%, driven mainly by an increase in postpartum strokes (Figure). Among all PAS, 3635 (59.6%), occurred in antepartum period and 2465 (40.4%) occurred in postpartum period. Compared to antepartum PAS, people hospitalized with postpartum PAS were more likely to be ≥35 years old (31% vs 23%, p=0.002), Black (29% vs 22%, p=0.003), and more likely to have hypertensive disorders of pregnancy (57% vs 34%, p=0.003), but less likely to have diabetes (6% v 11%, p=0.003). Furthermore, postpartum PAS was associated with a similar fatality rate (4.1%) compared to antepartum PAS (Table).

Conclusion:

In the U.S., we found an increasing trend in the rate of PAS, mostly in the postpartum period. Identification of modifiable factors and interventions associated with postpartum PAS may reduce the rate of PAS.