Abstract
Introduction: Stroke and other cerebrovascular events (CVE) are feared complications of pregnancy. Prior studies have reported an increased risk of CVE during the postpartum period, but these studies have not reported event rates after hospital discharge for labor and delivery. Methods: We performed a retrospective cohort study using the California State Inpatient and Emergency Department administrative databases to identify all pregnant women who went into labor at a non-federal, acute-care hospital from 2005 through 2011 and who were discharged without an ICD-9-CM diagnosis of cerebrovascular disease. The primary outcome was a CVE composite defined as any ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, subdural hemorrhage, cerebral sinus thrombosis, pituitary apoplexy, cerebral artery dissection, or hypertensive encephalopathy, occurring after hospital discharge and prior to 6 weeks after admission for labor and delivery. Descriptive statistics were used to calculate the incidence of postpartum CVE after hospital discharge and multivariate logistic regression was used to evaluate the association between several a priori selected clinical factors and postpartum CVE. Results: A total of 2,065,330 patients were included in this analysis. The rate of any CVE was 9.97 per 100,000 patients (95% CI 8.61-11.3). The mortality rate in patients with CVE was 7.8% (95% CI 4.1-11%). The mean age of patients with a CVE was 31.0 years as compared to 28.3 years in patients without a CVE (p<0.001). Risk factors for any CVE were eclampsia (OR 19.9, 95% CI 6.43-61.4), chronic kidney disease (OR 3.88, 95% CI 1.02-14.8), black race (OR 3.19, 95% CI 2.26-4.50), preeclampsia (OR 2.67, 95% CI 1.99-3.59), and age (OR 1.07 per year, 95% CI 1.05-1.09). Conclusion: The incidence of postpartum CVE after hospital discharge for labor and delivery is similar to rates reported for all postpartum events in prior publications. This suggests that a substantial proportion of postpartum cerebrovascular complications occur after hospital discharge. Therefore, clinicians should be aware that postpartum women remain at risk for stroke even if they have been discharged from their initial labor and delivery hospitalization without complication.
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