Temporal Trends in Pregnancy‐Associated Stroke and Its Outcomes Among Women With Hypertensive Disorders of Pregnancy

• Type of Material: Article
• Authors: Pensée Wu, Keele University; Kelvin P. Jordan, Keele University; Carolyn A. Chew-Graham, Keele University; Thais Coutinho, University of Ottawa; Gina Lundberg, Emory University; Ki E. Park, University of Florida; Lucy C. Chappell, King’s College London; Phyo K. Myint, University of Aberdeen; Angela H. E. M. Maas, Radboud University; Mamas A. Mamas, Keele University
• Language: English
• Date: 2020-08-04
• Publisher: Wiley
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.120.016182
• Title of Journal or Parent Work: Journal of the American Heart Association
• Volume: 9
• Issue: 15
• Grant/Funding Information: Dr Wu is funded by a National Institute for Health Research (NIHR) Transitional Research Fellowship (TRF‐2017‐10‐005). Dr Chew‐Graham is part‐funded by West Midlands ARC. Dr Chappell is funded by a NIHR Professorship (RP‐2014‐05‐019). This paper presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
• Keywords: pregnancy; Epidemiology; stroke in young adults; preeclampsia/pregnancy
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Medicine and Surgery

Abstract

Background Stroke is a serious complication of hypertensive disorders of pregnancy (HDP), with potentially severe and long‐term sequelae. However, the temporal trends, predictors, and outcomes of stroke in women with HDP at delivery remain unknown. Methods and Results All HDP delivery hospitalizations with or without stroke event (ischemic, hemorrhagic, or unspecified) between 2004 and 2014 in the United States National Inpatient Sample were analyzed to examine incidence, predictors, and prognostic impact of stroke. Of 4 240 284 HDP delivery hospitalizations, 3391 (0.08%) women had stroke. While the prevalence of HDP increased over time, incident stroke rates decreased from 10 to 6 per 10 000 HDP delivery hospitalizations between 2004 and 2014. Women with stroke were increasingly multimorbid, with some risk factors being more strongly associated with ischemic strokes, including congenital heart disease, peripheral vascular disease, dyslipidemia, and sickle cell disease. Delivery complications were also associated with stroke, including cesarean section (odds ratio [OR], 1.58; 95% CI, 1.33–1.86), postpartum hemorrhage (OR, 1.91; 95% CI, 1.33–1.86), and maternal mortality (OR, 99.78; 95% CI, 59.15–168.31), independently of potential confounders. Women with stroke had longer hospital stays (median, 6 versus 3 days), higher hospital charges (median, $14 655 versus $4762), and a higher proportion of nonroutine discharge locations (38% versus 4%). Conclusions The incidence of stroke in women with HDP has declined over time. While a relatively rare event, identification of women at highest risk of ischemic or hemorrhagic stroke on admission for delivery is important to reduce long‐term sequelae.