Temporal trends in pregnancy-associated stroke and its outcomes among women with hypertensive disorders of pregnancy

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 hospitalisations with or without stroke event (ischaemic, haemorrhagic, or unspecified) between 2004 and 2014 in the United States National Inpatient Sample were analysed to examine incidence, predictors and prognostic impact of stroke. Of 4,240,284 HDP delivery hospitalisations, 3,391 (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 hospitalisations between 2004 and 2014. Women with stroke were increasingly multimorbid with some risk factors being more strongly associated with ischaemic strokes, including congenital heart disease, peripheral vascular disease, dyslipidaemia and sickle cell disease. Delivery complications were also associated with stroke, including Caesarean section (OR 1.58, 95% CI 1.33, 1.86), postpartum haemorrhage (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 vs. 3 days), higher hospital charges (median $14,655 vs. $4,762) and a higher proportion of non-routine discharge locations (38% vs. 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 ischaemic or haemorrhagic stroke on admission for delivery is important to reduce long-term sequelae