Pregnancy associated stroke and hypertension: a national cohort evaluating temporal trends, risk factors, and mortality

Abstract

Our aim was to evaluate the association between pregnancy associated stroke (PAS) and hypertensive disorder in the U.S. The National Inpatient Sample was queried to identify hospitalizations in the U.S. with PAS (ischemic, hemorrhagic, cerebral venous thrombosis, and transient ischemic attack) from 01/2016 to 12/2019. Hypertensive disorders were defined as any of the following: chronic hypertension, gestational hypertension, preeclampsia, or eclampsia. Demographics, risk factors, outcomes and temporal trends of PAS with hypertension hospitalizations were compared to PAS without hypertensive hospitalizations. Differences were examined using the student’s t-test for continuous variables and χ2 tests categorical variables. Rates were reported per 100,000 hospitalizations. Among 15,977,644 pregnancy-associated hospitalizations, 6,100 had PAS, among them 2640 (43.3%) occurring in hospitalizations with hypertensive disorders of pregnancy. The rate of PAS among those with hypertension increased by 15.4% over the study period (p=.013, Figure). Hospitalizations with PAS and hypertensive disorders were more likely to be ≥35 years old (34% vs 21%, p< 0.001), Black (33% vs 19%, p< 0.001), have diabetes (14% vs 6%, p< 0.001) and obese (20% vs 10%, p< 0.001) compared to those without hypertensive disorders. PAS with hypertensive disorder was more likely to be hemorrhagic than PAS without hypertensive disorders. Fatality rate was similar between PAS with hypertensive disorders or without (4.8% vs 3.2%, p=0.12)(Table). A nationally representative sample of hospitalizations in the U.S. indicates an increasing trend in the rate of PAS, with almost half of them having concomitant hypertensive disorders. With an aging maternal population, hypertension and PAS hospitalizations were more likely to have other comorbidities related to metabolic syndrome such as obesity and diabetes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)