WSO - April 2023 - 445

1116209
WSO
International Journal of StrokeGarg et al.
Research
In-hospital outcomes and recurrence
of stroke during pregnancy and
puerperium
Aayushi Garg*
Abstract
Background: There are limited data regarding the best management and outcomes of acute stroke during pregnancy
and the puerperium.
Methods: Pregnancy-related hospitalizations with age > 18 years were identified from the Nationwide Readmissions
Database 2016-2018. The study cohort consisted of all patients with acute stroke and a 5% random sample of the
remaining non-stroke hospitalizations. Logistic regression and survival analyses were used to compare the in-hospital
outcomes and readmissions in patients with and without acute stroke.
Results: There were 11,829,044 pregnancy-related hospitalizations, of which 4057 had acute stroke. The mean ± SD
age of the study cohort was 29.0 ± 5.7 years. Among patients with acute ischemic stroke, 60 (3.7%) patients received
intravenous thrombolysis and 112 (6.8%) patients underwent endovascular thrombectomy. Among patients with intracranial
hemorrhage, 205 (10.5%) patients underwent ventriculostomy and 18 (0.9%) patients underwent decompressive
craniotomy. Patients with stroke had longer length of stay (mean: 10.7 vs 2.7 days), higher in-hospital mortality (4.6% vs
0.0001%) and were less likely to discharge home (73.0% vs 98.6%). Non-elective readmission within 90 days of discharge
occurred in 14.8% of patients with stroke versus in 3.9% of patients without stroke. Readmissions due to cerebrovascular
events occurred in 2.3% of patients with stroke versus in 0.007% of patients without stroke within 1 year of
discharge, with mean ± SD time to readmission 66.2 ± 78.0 days.
Conclusion: Stroke is a serious complication of pregnancy, associated with high morbidity and mortality. Recurrence
of stroke occurs in a small proportion of patients, and the risk is highest during the initial 3 months.
Keywords
Maternal stroke, readmissions, recurrence, subarachnoid hemorrhage, intracranial hemorrhage, ischemic infarct
Received: 13 April 2022; accepted: 1 July 2022
, Hannah Roeder* and Enrique C Leira
International Journal of Stroke
2023, Vol. 18(4) 445 -452
© 2022 World Stroke Organization
Article reuse guidelines:
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DOI: 10.1177/17474930221116209
journals.sagepub.com/home/wso
https://doi.org/10.1177/17474930221116209
Introduction
suggest an increasing incidence of maternal stroke over the
last two decades.2,3
Pregnancy is a sex-specific cerebrovascular risk factor.
Physiologic changes in cardiovascular function, coagulation,
connective tissue, and immune function that occur
during a healthy pregnancy, and obstetric complications,
such as hypertensive disorders of pregnancy, contribute to
the increased risk of stroke during pregnancy and the postpartum
period. Maternal stroke, defined as arterial ischemic
stroke (AIS), cerebral venous sinus thrombosis (CVST), or
intracerebral hemorrhage (ICH) during pregnancy and the
postpartum period, complicates approximately 30 per
100,000 deliveries, which is several times higher than the
overall rate of stroke among young adults.1 Some studies
Maternal stroke is a major public health issue, but several
unanswered questions persist, specifically regarding
Department of Neurology, University of Iowa Hospitals and Clinics,
Iowa City, IA, USA
*These authors contributed equally.
Corresponding author:
Aayushi Garg, Department of Neurology, University of Iowa Carver
College of Medicine, 200 Hawkins Dr., Iowa City, IA 52242, USA.
Email: Aayushigarg18@gmail.com
International Journal of Stroke, 18(4)
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