Association of Primary Intracerebral Hemorrhage With Pregnancy and the Postpartum Period

Abstract

IMPORTANCE Intracerebral hemorrhage (ICH) during pregnancy and the postpartum period results in catastrophic maternal outcomes. There is a paucity of population-based estimates of pregnancyrelated ICH risk, including risk during the extended postpartum period. OBJECTIVE To evaluate ICH risk during pregnancy and an extended 24-week postpartum period in a population-level cohort and to determine fetal and maternal outcomes as well as demographic and comorbidity factors associated with ICH during pregnancy and post partum. DESIGN, SETTING, AND PARTICIPANTS This study used a cohort-crossover design in which patients serve as their own controls when no longer exposed (pregnant or post partum). Administrative data were obtained from all hospital admissions for New York, California, and Florida for a 7-to 10-year period. Participants included all women admitted for labor and delivery who were older than 12 years and did not have a prior diagnosis of ICH. Conditional Poisson regression models were used to evaluate ICH risk, and data were reported as rate ratios and 95% CIs. Data analysis was performed from August 2018 to February 2020. EXPOSURES Women were tracked using hospitalization records for the duration of pregnancy (40 weeks), for 24 weeks post partum, and for an additional 64 weeks when no longer exposed. MAIN OUTCOMES AND MEASURES Diagnosis of ICH during both 64-week observation periods was determined using validated International Classification of Diseases, Ninth Revision codes. RESULTS A total of 3 314 945 pregnant women were included (mean [SD] age, 28.17 [6.47] years; 1 451 780 white [43.79%], 474 808 black [14.32%], 246 789 Asian [7.44%], and 835 917 Hispanic [25.22%]). The risk of ICH was significantly higher during the third trimester (2.9 vs 0.7 cases per 100 000 pregnancies; rate ratio, 4.16; 95% CI, 2.52-6.86) and remained elevated during the first 12 weeks post partum (4.4 vs 0.5 cases per 100 000 pregnancies; rate ratio, 9.15; 95% CI, 5.16-16.23).

Spontaneous Intracerebral Hemorrhage (ICH) associated with pregnancy and SARS-CoV-2 infection: a case report

“…In addition to the increased risk of spontaneous ICH in patients with COVID-19, pregnancy itself can be considered as a risk factor for nontraumatic ICH. about which, Meeks et al demonstrated an increased rate of ICH during the third trimester and the first 12 postpartum weeks [ 13 ]. Data from previous studies demonstrated an increase in the risk of ICH in pregnant women with eclampsia, gestational hypertension, coagulopathy, and history of tobacco use by increasing the states of cerebral hyper-perfusion [ 13 ].…”

“…about which, Meeks et al demonstrated an increased rate of ICH during the third trimester and the first 12 postpartum weeks [ 13 ]. Data from previous studies demonstrated an increase in the risk of ICH in pregnant women with eclampsia, gestational hypertension, coagulopathy, and history of tobacco use by increasing the states of cerebral hyper-perfusion [ 13 ]. However, we observed none of these factors in this case.…”

Intracranial hematoma and abscess after neuraxial analgesia and anesthesia: a review of the literature describing 297 cases

“…42 43 This may be related to an increased circulating volume, presence of pre-existing cranial vascular anomalies, coagulopathy or hypertensive disorders such as preexisting hypertension and pre-eclampsia/eclampsia. [42][43][44] The effect of a neuraxial block on the risk of intracranial bleeding in pregnant or direct postpartum women is unknown.…”

Current Resources for Evidence‐Based Practice, March/April 2021

“…What may be less well recognized is the more immediate short‐term risk following a pregnancy with HDP. About 6% of maternal deaths are caused by HDPs, 5 and they may contribute to cerebrovascular and other cardiovascular deaths as well 6 . More importantly, 60% of these deaths occur in the first 6 weeks postpartum 7 .…”