Abstract HUP1: Health Inequities in Preeclampsia and Maternal Ischemic Stroke: A Cross-Sectional Analysis of the National Inpatient Sample

Abstract

Introduction: Maternal stroke affects 30 per 100,000 pregnancies, a 3-fold higher risk as compared to stroke rate in young adults. One study reported that preeclampsia (PE) or eclampsia was seen in 36% of pregnant patients with ischemic stroke. The objective of this study is to evaluate the odds of PE and maternal ischemic stroke (MIS) in a national sample. Methods: We utilized the National Inpatient Sample from Q4 2015 to 2020 to examine the rates of PE and MIS in women aged 20-44. To be included in the analysis, the primary Major Diagnostic Category (MDC) code on the record was for Pregnancy, Childbirth, and Puerperium (n=3,921,672) or Newborn and Other Neonates, Perinatal Period (n=178). Univariate analysis provided crude odds of relevant variables. Multivariate logistic regression models were fitted to determine the odds of PE based on known PE risk factors; a second model was fitted to determine the odds of maternal stroke in women who had PE. Covariates in both models were age, primary payer, gestational diabetes, and obesity. Results: Consistent with previous knowledge, univariate analysis showed that Black women had 69% higher odds of PE compared to white women (cOR=1.69, 95%CI=1.66-1.71), while Latinas had 8% higher odds of PE compared to white women (cOR=1.08, 95%Ci=1.06-1.11). Compared to white women, Black women had 42% increased odds of MIS (cOR=1.42, 95%CI=1.14-1.78), while Latinas had 24% decreased odds of MIS (cOR=0.76, 95%CI=0.59-0.99). In multivariate analysis, PE was associated with increased odds of MIS, aOR=1.74 (95% CI=1.31-2.31). When stratified by race, this result was only found among white women (aOR=1.85, 95% CI=1.26-2.75). Having PE was not associated with odds of MIS in Black women when compared to Black women without PE (aOR=1.52, 95% CI=0.90-2.56). Conclusion: This study found that preeclampsia increases the odds of MIS overall. These odds are higher if patients also have other risk factors such as gestational diabetes, history of hypertension, and history of stroke. Our results also found no significant difference in MIS among Black women or Latinas based on PE status. Future directions could address other potential contributing factors, including structural factors that contribute to health inequities.