Infection During Delivery Hospitalization and Risk of Readmission for Postpartum Stroke

Stroke vs. Preeclampsia: Dangerous Liaisons of Hypertension and Pregnancy

Stroke during pregnancy and preeclampsia are two distinct but interrelated medical conditions, sharing a common denominator-blood control failure. Along with cardiovascular diseases, diabetes, dyslipidemia, and hypercoagulability, hypertension is undoubtedly a major risk factor associated with stroke. Even though men have higher age-specific stroke rates, women are facing higher life-long stroke risk, primarily due to longer life expectancy. Sex hormones, especially estrogen and testosterone, seem to play a key link in the chain of blood pressure control differences between the genders. Women affected with stroke are more susceptible to experience some atypical stroke manifestations, which might eventually lead to delayed diagnosis establishment, and result in higher morbidity and mortality rates in the population of women. Preeclampsia is a part of hypertensive disorder of pregnancy spectrum, and it is common knowledge that women with a positive history of preeclampsia are at increased stroke risk during their lifetime. Preeclampsia and stroke display similar pathophysiological patterns, including hypertension, endothelial dysfunction, dyslipidemia, hypercoagulability, and cerebral vasomotor reactivity abnormalities. High-risk pregnancies carrying the burden of hypertensive disorder of pregnancy have up to a six-fold higher chance of suffering from stroke. Resemblance shared between placental and cerebral vascular changes, adaptations, and sophisticated auto-regulatory mechanisms are not merely coincidental, but they reflect distinctive and complex cardiovascular performances occurring in the maternal circulatory system during pregnancy. Placental and cerebral malperfusion appears to be in the midline of both of these conditions; placental malperfusion eventually leads to preeclampsia, and cerebral to stoke. Suboptimal performances of the cardiovascular system are proposed as a primary cause of uteroplacental malperfusion. Placental dysfunction is therefore designated as a secondary condition, initiated by the primary disturbances of the cardiovascular system, rather than an immunological disorder associated with abnormal trophoblast invasion. In most cases, with properly and timely applied measures of prevention, stroke is predictable, and preeclampsia is a controllable condition. Understanding the differences between preeclampsia and stroke in pregnancy is vital for healthcare providers to enhance their clinical decision-making strategies, improve patient care, and promote positive maternal and pregnancy outcomes. Management approaches for preeclampsia and stroke require a multidisciplinary approach involving obstetricians, neurologists, and other healthcare professionals.

Stroke Around Pregnancy; Protection and Prevention!

As per recent studies, incidence of stroke is increasing in pregnant women. It is essential to be vigilant and well-versed in managing stroke in pregnancy, as both the mother and the baby are prone to stroke-related injury. In this viewpoint article, we have reviewed the current data from research publications on the incidence, prevalence, risk factors, and clinical presentation of stroke in pregnancy. Finally, we have discussed the plan of investigations and the current treatment guidelines for stroke in pregnancy.

Association Between Mental Health Conditions at the Hospitalization for Birth and Postpartum Hospital Readmission

Background: The relationship between physical comorbidities and postpartum hospital readmission is well studied, with less research regarding the impact of mental health conditions on postpartum readmission. Methods: Using hospital discharge data (2016-2019) from the Hospital Cost and Utilization Project Nationwide Readmissions Database (n = 12,222,654 weighted), we evaluated the impact of mental health conditions (0, 1, 2, and ≥3), as well as five individual conditions (anxiety, depressive, bipolar, schizophrenic, and traumatic/stress-related conditions) on readmission within 42 days, 1-7 days ("early"), and 8-42 days ("late") of hospitalization for birth. Results: In adjusted analyses, the rate of 42-day readmission was 2.2 times higher for individuals with ≥3 mental health conditions compared to those with none (3.38% vs. 1.56%; p < 0.001), 50% higher among individuals with 2 mental health conditions (2.33%; p < 0.001), and 40% higher among individuals with 1 mental health condition (2.17%; p < 0.001). We found increased adjusted risk of 42-day readmission for individuals with anxiety (1.98% vs. 1.59%; p < 0.001), bipolar (2.38% vs. 1.60%; p < 0.001), depressive (1.93% vs. 1.60%; p < 0.001), schizophrenic (4.00% vs. 1.61%; p < 0.001), and traumatic/stress-related conditions (2.21% vs. 1.61%; p < 0.001), relative to individuals without the respective condition. Mental health conditions had larger impacts on late (8-42 day) relative to early (1-7 day) readmission. Conclusions: This study found strong relationships between mental health conditions during the hospitalization for birth and readmission within 42 days. Efforts to reduce the high rates of adverse perinatal outcomes in the United States should continue to address the impact of mental health conditions during pregnancy and throughout the postpartum period.

Deliveries Among Patients With Maternal Hepatitis C Virus Infection in the United States, 2000-2019

OBJECTIVE

To assess clinical characteristics, trends, and outcomes associated with the diagnosis of hepatitis C virus (HCV) infection during pregnancy.

METHODS

This cross-sectional study analyzed delivery hospitalizations using the National Inpatient Sample. Temporal trends in both diagnosis of HCV infection and clinical characteristics associated with HCV infection were analyzed using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. Survey-adjusted logistic regression models were fit to assess the association among HCV infection and preterm delivery, cesarean delivery, and severe maternal morbidity (SMM), adjusting for clinical, medical, and hospital factors with adjusted odds ratios (aORs) as the measure of association.

RESULTS

An estimated 76.7 million delivery hospitalizations were included, in which 182,904 (0.24%) delivering individuals had a diagnosis of HCV infection. The prevalence of HCV infection diagnosed in pregnancy increased nearly 10-fold over the study period, from 0.05% in 2000 to 0.49% in 2019, representing an AAPC of 12.5% (95% CI 10.4-14.8%). The prevalence of clinical characteristics associated with HCV infection also increased over the study period, including opioid use disorder (from 10 cases/10,000 birth hospitalizations to 71 cases/10,000 birth hospitalizations), nonopioid substance use disorder (from 71 cases/10,000 birth hospitalizations to 217 cases/10,000 birth hospitalizations), mental health conditions (from 219 cases/10,000 birth hospitalizations to 1,117 cases/10,000), and tobacco use (from 61 cases/10,000 birth hospitalizations to 842 cases/10,000). The rate of deliveries among patients with two or more clinical characteristics associated with HCV infection increased from 26 cases per 10,000 birth hospitalizations to 377 cases per 10,000 delivery hospitalizations (AAPC 13.4%, 95% CI 12.1-14.8%). In adjusted analyses, HCV infection was associated with increased risk for SMM (aOR 1.78, 95% CI 1.61-1.96), preterm birth (aOR 1.88, 95% CI 1.8-1.95), and cesarean delivery (aOR 1.27, 95% CI 1.23-1.31).

CONCLUSION

Diagnosis of HCV infection is increasingly common in the obstetric population, which may reflect an increase in screening or a true increase in prevalence. The increase in HCV infection diagnoses occurred in the setting of many baseline clinical characteristics that are associated with HCV infection becoming more common.

Trends in and outcomes associated with obstructive sleep apnea during deliveries in the United States, 2000-2019

BACKGROUND

Population-level data on obstructive sleep apnea among pregnant women in the United States and associated risk for adverse outcomes during delivery may be of clinical importance and public health significance.

OBJECTIVE

This study aimed to assess trends in and outcomes associated with obstructive sleep apnea during delivery hospitalizations.

STUDY DESIGN

This repeated cross-sectional study analyzed delivery hospitalizations using the National Inpatient Sample. Temporal trends in obstructive sleep apnea were analyzed using joinpoint regression to estimate the average annual percentage change with 95% confidence intervals. Survey-adjusted logistic regression models were fit to assess the association between obstructive sleep apnea and mechanical ventilation or tracheostomy, acute respiratory distress syndrome, hypertensive disorders of pregnancy, peripartum hysterectomy, pulmonary edema/heart failure, stillbirth, and preterm birth.

RESULTS

From 2000 to 2019, an estimated 76,753,013 delivery hospitalizations were identified, of which 54,238 (0.07%) had a diagnosis of obstructive sleep apnea. During the study period, the presence of obstructive sleep apnea during delivery hospitalizations increased from 0.4 to 20.5 cases per 10,000 delivery hospitalizations (average annual percentage change, 20.6%; 95% confidence interval, 19.1-22.2). Clinical factors associated with obstructive sleep apnea included obesity (4.3% of women without and 57.7% with obstructive sleep apnea), asthma (3.2% of women without and 25.3% with obstructive sleep apnea), chronic hypertension (2.0% of women without and 24.5% with obstructive sleep apnea), and pregestational diabetes mellitus (0.9% of women without and 10.9% with obstructive sleep apnea). In adjusted analyses accounting for obesity, other clinical factors, demographics, and hospital characteristics, obstructive sleep apnea was associated with increased odds of mechanical ventilation or tracheostomy (adjusted odds ratio, 21.9; 95% confidence interval, 18.0-26.7), acute respiratory distress syndrome (adjusted odds ratio, 5.9; 95% confidence interval, 5.4-6.5), hypertensive disorders of pregnancy (adjusted odds ratio, 1.6; 95% confidence interval, 1.6-1.7), stillbirth (adjusted odds ratio, 1.2; 95% confidence interval, 1.0-1.4), pulmonary edema/heart failure (adjusted odds ratio, 3.7; 95% confidence interval, 2.9-4.7), peripartum hysterectomy (adjusted odds ratio, 1.66; 95% confidence interval, 1.23-2.23), and preterm birth (adjusted odds ratio, 1.2; 95% confidence interval, 1.1-1.2).

CONCLUSION

Obstructive sleep apnea diagnoses are increasingly common in the obstetrical population and are associated with a range of adverse obstetrical outcomes during delivery hospitalizations.

Risk of Postpartum Flare Hospitalizations in Patients with Inflammatory Bowel Disease Persists After Six Months

BACKGROUND

Although patients with IBD are at higher risk for flares during the postpartum period, little is known about the risk factors, timeline, and healthcare-associated costs of a readmission flare.

AIMS

To ascertain the timeline in which patients are hospitalized for postpartum inflammatory bowel disease (IBD) flares, and the associated risk factors.

METHODS

This is a nationwide retrospective cohort study of 7054 patients with IBD who delivered between 2010-2014 obtained from the National Readmissions Database. The presence of IBD was defined using previously validated International Classification of Diseases codes, and univariable and multivariable regression models were performed to assess risk factors associated with a postpartum flare hospitalization over the nine-month observation period.

RESULTS

A total of 353 (5.0%) patients were hospitalized for a postpartum IBD flare, with approximately one-third (30.0%) readmitted after 6 months. On multivariable analysis, having Crohn's disease (aRR 1.47, 95%CI 1.16-1.88), Medicare insurance (aRR 3.30, 95%CI 2.16-5.02), and ≥ 2 comorbidities (aRR 1.34, 95%CI 1.03-1.74) were independently associated with a higher risk of an IBD flare hospitalization. Compared to patients aged 25-29, those 20-24 were at higher risk for an IBD flare readmission (aRR 1.58, 95%CI 1.17-2.13), whereas patients aged 35-39 years were at lower risk (aRR 0.63, 95%CI 0.43-0.92).

CONCLUSIONS

Among patients with IBD, Crohn's disease, Medicare insurance, multiple comorbidities, and younger age were independent risk factors for a postpartum IBD flare hospitalization. As approximately one-third of these readmissions occurred after 6 months, it is imperative to ensure adequate follow-up and treatment for postpartum IBD patients, particularly in the extended postpartum period.

Trends and outcomes for deliveries with hypertensive disorders of pregnancy from 2000 to 2018: A repeated cross-sectional study

OBJECTIVE

To analyse trends, risk factors, and outcomes related to hypertensive disorders of pregnancy (HDP).

DESIGN

Repeated cross-sectional.

SETTING

US delivery hospitalisations.

POPULATION

Delivery hospitalisations in the 2000-2018 National Inpatient Sample.

METHODS

US hospital delivery hospitalisations with HDP were analysed. Several trends were analysed: (i) the proportion of deliveries by year with HDP, (ii) the proportion of deliveries with HDP risk factors and (iii) adverse outcomes associated with HDP including maternal stroke, acute renal failure and acute liver injury. Risk ratios were determined using regression models with HDP as the exposure of interest.

MAIN OUTCOME MEASURES

Prevalence of HDP, risk factors for HDP and associated adverse outcomes.

RESULTS

Of 73.1 million delivery hospitalisations, 7.7% had an associated diagnosis of HDP. Over the study period, HDP doubled from 6.0% of deliveries in 2000 to 12.0% in 2018. The proportion of deliveries with risk factors for HDP increased from 9.6% in 2000 to 24.6% in 2018. In adjusted models, HDP were associated with increased stroke (aRR [adjusted risk ratio] 15.9, 95% CI 14.8-17.1), acute renal failure (aRR 13.8, 95% CI 13.5-14.2) and acute liver injury (aRR 1.2, 95% CI 1.2-1.3). Among deliveries with HDP, acute renal failure and acute liver injury increased; in comparison, stroke decreased.

CONCLUSION

Hypertensive disorders of pregnancy increased in the setting of risk factors for HDP becoming more common, whereas stroke decreased.

TWEETABLE ABSTRACT

While hypertensive disorders of pregnancy increased from 2000 to 2018, stroke appears to be decreasing.

Differences in Stroke or Systemic Thromboembolism Readmission Risk After Hospitalization for Atrial Fibrillation and Atrial Flutter

Background

Although atrial fibrillation (AF) and atrial flutter (AFL) are different arrhythmias, they are assumed to confer the same risk of stroke and systemic thromboembolism (STE) despite a lack of available evidence. In this study, we investigated the difference in the risk of stroke or STE after AF and AFL hospitalizations.

Methodology

The National Readmission Database (NRD) 2018 was used to identify AF and AFL patients using appropriate International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and were followed until the end of the calendar year to identify stroke or STE readmissions. Survival estimates were calculated, and a Cox proportional hazards model was used to calculate the adjusted hazards ratio (aHR) and compare the risk of stroke or STE readmissions between AF and AFL groups.

Results

A total of 215,810 AF and 15,292 AFL patients were identified. AFL patients were more likely to be younger (66 vs. 70 years), male (68% vs. 47%), and had higher prevalence of obesity (25% vs. 22%), obstructive sleep apnea (14% vs. 12%), diabetes mellitus (31% vs. 26%), and alcohol use (6.9% vs. 5.5%) (all p < 0.01). After adjusting for potential patient and hospital-level characteristics, there was a statistically significant decrease in one-year stroke or STE readmission risk in AFL patients compared to AF patients (aHR 0.79 (0.66-0.95); p = 0.01).

Conclusions

AFL patients are commonly younger males with a higher burden of medical comorbidity. There is a decrease in the one-year risk of stroke or STE events in AFL patients compared to AF. The predictors of stroke and STE are similar in both AFL and AF groups. Further studies with longer follow-up and anticoagulation data are needed to verify the results.

Influenza Complicating Delivery Hospitalization and Its Association With Severe Maternal Morbidity in the United States, 2000-2018

OBJECTIVE

To characterize trends of an influenza diagnosis at delivery hospitalization and its association with severe maternal morbidity.

METHODS

We conducted a repeated cross-sectional analysis of delivery hospitalizations using the Nationwide Inpatient Sample from 2000 to 2018. We assessed the association between an influenza diagnosis at delivery hospitalization and severe maternal morbidity excluding transfusion per Centers for Disease Control and Prevention criteria. Secondary outcomes included maternal death and morbidity measures associated with influenza (mechanical intubation and ventilation, sepsis and shock, and acute respiratory distress syndrome [ARDS]) and obstetric complications (preterm birth and hypertensive disorders of pregnancy). We assessed trends of severe maternal morbidity by annual influenza season and the association between influenza and severe maternal morbidity using multivariable log-linear regression, adjusting for demographic, clinical, and hospital characteristics.

RESULTS

Of 74.7 million delivery hospitalizations, 23 per 10,000 were complicated by an influenza diagnosis. The rate of severe maternal morbidity was higher with an influenza diagnosis compared with those without influenza (86-410 cases vs 53-70 cases/10,000 delivery hospitalizations). Women with an influenza diagnosis at delivery hospitalization were at an increased risk of severe maternal morbidity compared with those without influenza (2.3 vs 0.7%; adjusted risk ratio 2.24, 95% CI 2.17-2.31). This association held for maternal death, mechanical intubation, sepsis and shock, and ARDS-as well as obstetric complications, including preterm birth and hypertensive disorders of pregnancy.

CONCLUSION

Pregnant women with influenza are at increased risk of severe maternal morbidity, as well as influenza-related maternal and obstetric complications. These results emphasize the importance of primary prevention and recognition of influenza infection during pregnancy to reduce downstream maternal morbidity and mortality.

Associations of influenza, chronic comorbid conditions, and severe maternal morbidity among U.S. pregnant women with influenza at delivery hospitalization, 2000-2015

BACKGROUND

Chronic comorbid conditions increase the risk of influenza-related morbidity. Whether this holds for pregnant women who are at high risk of complications from influenza remains to be determined.

OBJECTIVES

To determine whether chronic comorbid conditions are associated with an increased risk of severe maternal morbidity (SMM) among pregnant women with an influenza diagnosis at delivery hospitalization.

STUDY DESIGN

We performed a cross-sectional analysis of delivery hospitalizations complicated by an influenza diagnosis using the National Inpatient Sample from 2000-2015. We assessed four prevalent chronic comorbid conditions associated with increased influenza-complications outside of pregnancy, obstructive lung disease (asthma and chronic obstructive pulmonary disease [COPD]), chronic hypertension, obesity, and pregestational diabetes, overall and individually. The primary outcome was SMM excluding transfusion as defined by the Centers for Disease Control and Prevention, and secondarily, specific SMM measures recognized as influenza-related complications, acute respiratory distress syndrome (ARDS), mechanical intubation and ventilation, and sepsis and shock. Multivariable survey-weighted log linear models were used, adjusting for patient, hospital, and clinical characteristics.

RESULTS

Of 62.7 million delivery hospitalizations, 0.2% (n=144,572) were complicated by an influenza diagnosis at delivery hospitalization (23 cases of influenza per 10,000 delivery hospitalizations), and 24.9% (n=36,054) with 1 or more chronic comorbid conditions, of which 77.4% included obstructive lung disease. Pregnant women with an influenza diagnosis at delivery hospitalization with a chronic comorbid condition had a slightly higher risk of SMM compared to those without (2.6% vs. 1.7%; adjusted risk ratio (aRR): 1.11; 95% CI: 1.03, 1.21), as well as ARDS (0.9% vs. 0.5%; aRR: 1.42; 95% CI: 1.23, 1.64) and mechanical intubation and ventilation (0.2% vs. 0.1%; aRR: 1.92; 95% CI: 1.37, 2.69), but a lower risk of sepsis and shock (0.2% vs. 0.3%; aRR: 0.57; 95% CI: 0.45, 0.73). Regarding specific conditions, obstructive lung disease was associated with an increased risk of SMM (adjusted risk ratio (aRR): 1.21; 95% CI: 1.11, 1.32), as well as ARDS (aRR: 1.54; 95% CI: 1.32, 1.79) and mechanical intubation and ventilation (aRR: 2.80; 95% CI: 2.00, 3.91). Chronic hypertension was associated with an increased risk of ARDS (aRR: 1.70; 95% CI: 1.16, 2.49), but a lower risk of sepsis and shock (aRR: 0.34; 95% CI: 0.13, 0.85). Obesity was associated with a lower risk of SMM (aRR: 0.84; 95% CI: 0.74, 0.97). Pregestational diabetes was not associated with SMM.

CONCLUSIONS

Among women with a diagnosis of influenza at delivery hospitalization, chronic comorbid conditions may increase the risk of SMM, and in particular, those outcomes related to influenza. These results can inform efforts to increase influenza vaccination for pregnant women with chronic comorbidities.

Stroke in Pregnancy: A Multidisciplinary Approach

Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. Hypertensive disorders of pregnancy and gestational hypercoagulability are important contributors to obstetric stroke. Preeclampsia and eclampsia confer risk for future cardiovascular disease. Hemorrhagic stroke is the most common type of obstetric stroke. Ischemic stroke can result from cardiomyopathy, paradoxical embolism, posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and dissections. Cerebral venous sinus thrombosis is a frequent complication of pregnancy.

Stroke associated with Mycoplasma hominis infection: a case report

BACKGROUND

Mycoplasmas are the smallest prokaryotic microorganisms in nature. Many cases of stroke post-Mycoplasma pneumoniae infection have been reported, particularly in the pediatric population. However, Mycoplasma hominis infection has not previously been associated with stroke.

CASE PRESENTATION

We report the case of a 36-year-old Greek woman who presented with an extensive stroke with an unspecified cause. She had a concurrent genital infection with Mycoplasma hominis for an unknown duration.

CONCLUSION

An association may exist between stroke and the immune response to Mycoplasma hominis infection.

The value of inflammatory factors and red blood cell immune indices in predicting perinatal infection in hypertensive women after cesarean section

OBJECTIVE

This study was conducted to explore the predictive value of inflammatory factors and red blood cell (RBC) immune indices in perinatal infection of women with pregnancy-induced hypertension after cesarean section.

METHODS

Eighty women with pregnancy-induced hypertension and perinatal infection after cesarean section were enrolled as the study group. Another 80 pregnant women with hypertension but without perinatal infection during cesarean section were included as the control group. The two groups were compared in terms of interleukin-1β (IL-1β), IL-6, IL-10, transformation growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), immune adhesion inhibitor (FEIR), immune adhesion promotion factor (FEER), and immune complex rosette (RBC-ICR) levels. The mothers in the study group were grouped according to the level of white blood cells, and the differences in related indicators of women in different inflammatory states were compared. Finally, the correlation between inflammatory factors and RBC-related immune indices was calculated. The differences in inflammatory factors and RBC-related immune indices were evaluated among different infection types. The ROC curve of IL-1β, IL-6, IL-10 and FEIR, FEER, RBC-ICR for infection prediction was plotted.

RESULTS

The study group showed significantly higher maternal levels of inflammatory factors and FEIR and lower FEER and RBC-ICR than the control group (P<0.05). There was a significant correlation between inflammatory factors and RBC-related immune indices (P<0.05), and there was little difference in inflammatory factors and RBC-related immune indices among different infection types (P>0.05). Inflammatory factors and RBC-related immune indices exhibited good predictive value for perinatal infection of women with pregnancy-induced hypertension.

CONCLUSION

Prior to perinatal infection, the inflammatory factors and the RBC indices of women with hypertension and cesarean section are significantly altered. Monitoring these indicators can be used to evaluate maternal prognosis.

Maternal Stroke: A Call for Action

Maternal mortality rates have been steadily increasing in the United States, and cardiovascular mortality is the leading cause of death among pregnant and postpartum women. Maternal stroke accounts for a significant burden of cardiovascular mortality. Data suggest that rates of maternal stroke have been increasing in recent years. Advancing maternal age at the time of birth and the increasing prevalence of traditional cardiovascular risk factors, and other risk factors, as well, such as hypertensive disorders of pregnancy, migraine, and infections, may contribute to increased rates of maternal stroke. In this article, we provide an overview of the epidemiology of maternal stroke, explore mechanisms that may explain increasing rates of stroke among pregnant women, and identify key knowledge gaps for future investigation in this area.

Maternal Race/Ethnicity, Hypertension, and Risk for Stroke During Delivery Admission

Background

Racial disparities contribute to maternal morbidity in the United States. Hypertension is associated with poor maternal outcomes, including stroke. Disparities in hypertension might contribute to maternal strokes.

Methods and Results

Using billing data from the Healthcare Cost and Utilization Project's National Inpatient Sample, we analyzed the effect of race/ethnicity on stroke during delivery admission in women aged 18 to 54 years delivering in US hospitals from January 1, 1998, through December 31, 2014. We categorized hypertension as normotensive, chronic hypertension, or pregnancy‐induced hypertension. Adjusted risk ratios (aRRs) and 95% CIs were calculated using log‐linear Poisson regression models, testing for interactions between race/ethnicity and hypertensive status. A total of 65 286 425 women were admitted for delivery during the study period, of whom 7764 were diagnosed with a stroke (11.9 per 100 000 deliveries). Hypertension modified the effect of race/ethnicity (P<0.0001 for interaction). Among women with pregnancy‐induced hypertension, black and Hispanic women had higher stroke risk compared with non‐Hispanic whites (blacks: aRR, 2.07; 95% CI, 1.86–2.30; Hispanics: aRR, 2.19; 95% CI, 1.98–2.43). Among women with chronic hypertension, all minority women had higher stroke risk (blacks: aRR, 1.71; 95% CI, 1.30–2.26; Hispanics: aRR, 1.75; 95% CI, 2.32–5.63; Asian/Pacific Islanders: aRR, 3.62; 95% CI, 2.32–5.63). Among normotensive women, only blacks had increased stroke risk (aRR, 1.17; 95% CI, 1.07–1.28).

Conclusions

Pregnant US women from minority groups had higher stroke risk during delivery admissions, compared with non‐Hispanic whites. The effect of race/ethnicity was larger in women with chronic hypertension or pregnancy‐induced hypertension. Targeting blood pressure management in pregnancy may help reduce maternal stroke risk in minority populations.

Ischemic stroke and cerebral venous sinus thrombosis in pregnancy

Maternal ischemic stroke and cerebral venous sinus thrombosis (CVST) are dreaded complications of pregnancy and major contributors to maternal disability and mortality. This chapter summarizes the incidence and risk factors for maternal arterial ischemic stroke (AIS) and CVST and discusses the pathophysiology of maternal AIS and CVST. The diagnosis, treatment, and secondary preventive strategies for maternal stroke are also reviewed. Special populations at high risk of maternal stroke, including women with moyamoya disease, sickle cell disease, HIV, thrombophilia, and genetic cerebrovascular disorders, are highlighted.