Maternal stroke tied to high morbidity, mortality

Women who experienced a stroke during pregnancy had higher rates of morbidity and mortality compared with those without stroke, according to a study presented at ISC 2022.

Using data from the Nationwide Readmissions Database between 2016 and 2018, the researchers conducted a study involving 631,604 women (mean age 29.0 years) who were hospitalized due to pregnancy-related conditions. Of these, 3,498 patients had a maternal stroke, defined as a diagnosis of intracranial haemorrhage (ICH; n=1,952), acute ischaemic stroke (AIS; n=1,646), or cerebral venous sinus thrombosis (CVST; n=105). [ISC 2022, abstract 158]

During hospitalization, patients with ICH underwent catheter angiogram, ventriculostomy, or decompressive craniectomy (24.0, 11.0, and 1.0 percent, respectively), and those with AIS underwent catheter angiogram, endovascular treatment, or received alteplase (10.0, 7.0, and 4.0 percent, respectively).

Patients with maternal stroke demonstrated a higher risk of arteriopathies or arterial lesions, such as reversible cerebral vasoconstriction syndrome (odds ratio [OR], 690.57), arteriovenous malformation (OR, 209.82), moyamoya disease (OR, 103.58), or intracranial aneurysm (OR, 85.97), compared with those without stroke.

“It is important to note that even though there was a much higher association between maternal stroke and the arteriopathies or arterial lesions, the traditional cerebrovascular risk factors also remained relevant in these patients,” said lead author Dr Aayushi Garg from the Department of Neurology at the University of Iowa in Iowa City, US.

Patients with stroke also had higher rates of in-hospital mortality than those without stroke (5.3 percent vs 0.01 percent; OR, 141.4; p<0.001) and longer duration of hospital stay (19.0 percent vs 2.7 percent; OR, 7.1; p<0.001).

In addition, those with stroke were more likely to require mechanical ventilation (19.3 percent vs 0.1 percent; OR, 88.1; p<0.001), tracheostomy (4.0 percent vs 0.0 percent; OR, 597.7; p<0.001), and gastrostomy tube placement (3.3 percent vs 0.0 percent; OR, 544.5; p<0.001) compared with those who did not have stroke.

A higher rate of non-routine discharge, defined as discharged not to home, short-term hospitals, rehabilitation facilities, or home health care, was noted among patients with vs without stroke (29.7 percent vs 1.6 percent; OR, 9.5; p<0.001).

The overall non-elective readmission rate within 90 days after discharge was also higher in the stroke vs non-stroke group (18.0 percent vs 3.0 percent). Among patients with stroke who had readmissions, 51.8 percent and 28.4 percent were due to pregnancy-related and non-neurological conditions, respectively.

Of the 8.6 percent of patients with stroke who had readmissions due to acute stroke within the first month after discharge, recurrence of stroke only occurred in 1.9 percent of the patients at a mean follow-up of 183 days, indicating that the risk of recurrence was higher during the first few weeks following discharge, noted Garg.

“Maternal stroke is strongly associated with [an increased risk of] predisposing arteriopathies or arterial lesions,” said Garg.

“[Moreover, it is] associated with significantly worse in-hospital outcomes including mortality and non-routine discharge, … [as well as] non-elective readmissions, with most readmissions due to pregnancy-related conditions,” she added.