Pregnancy, delivery and neonatal outcomes in women with a cerebrovascular-accident history prior to delivery - Evaluation of a population database
Objective: Cerebrovascular accidents (CVA) in childbearing-age women are rare. We aimed to evaluate the association between CVA events prior to delivery and obstetrical and neonatal outcomes. Methods: A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Proj...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Heliyon |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024016621 |
| _version_ | 1827322288738926592 |
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| author | Uri Amikam Ahmad Badeghiesh Haitham Baghlaf Richard Brown Michael H. Dahan |
| author_facet | Uri Amikam Ahmad Badeghiesh Haitham Baghlaf Richard Brown Michael H. Dahan |
| author_sort | Uri Amikam |
| collection | DOAJ |
| description | Objective: Cerebrovascular accidents (CVA) in childbearing-age women are rare. We aimed to evaluate the association between CVA events prior to delivery and obstetrical and neonatal outcomes. Methods: A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP–NIS) database. All pregnant women who delivered or had a maternal death in the US from 2004 to 2014 were included in the study. We performed a comparison between women with an ICD-9 diagnosis of CVA before the delivery admission and those without. Obstetrical and neonatal outcomes were compared between the two groups. Results: In total, 9,096,788 women fulfilled the inclusion criteria. Among them, 695 women (7.6 per 100,000) were diagnosed with a CVA before delivery. Women with a history of CVA, compared to those without, were more likely to be Black, older than 35 years of age, and suffer from obesity, chronic hypertension, pregestational diabetes, and thyroid disease. Patients with a prior CVA, compared to those without, had higher rates of pregnancy-induced hypertension (aOR 6.41, 95% CI 5.03–8.39, p < 0.001), preeclampsia (aOR 7.65, 95% CI 6.03–9.71, p < 0.001), and eclampsia (aOR 171.56, 95% CI 124.63–236.15, p < 0.001). Additionally, they had higher rates of preterm delivery (aOR 1.72, 95% CI 1.33–2.22,p = 0.003), cesarean section (aOR 2.69, 95% CI 2.15–3.37, p < 0.001), and maternal complications such as a peripartum hysterectomy (aOR 11.62, 95% CI 5.77–23.41, p < 0.001), postpartum hemorrhage (aOR 3.39, 95 % CI 2.52–4.54, p < 0.001), disseminated intravascular coagulation (aOR 16.32, 95% CI 11.33–23.52, p < 0.001), venous thromboembolism (aOR 45.08, 95% CI 27.17–74.8, p < 0.001), and maternal death (aOR 486.11, 95% CI 307.26–769.07, p < 0.001). Regarding neonatal outcomes, patients with a prior CVA, compared to those without, had a higher rate of intrauterine fetal demise and congenital anomalies. Conclusion: Women with a CVA event before delivery have a significantly higher incidence of maternal complications, including hypertensive disorders of pregnancy, and neonatal complications, such as intrauterine fetal demise and congenital anomalies. Rates of maternal death were dramatically increased, and this association requires further evaluation. |
| first_indexed | 2024-03-08T02:00:36Z |
| format | Article |
| id | doaj.art-2e4fad07104f48e1b456183c6b20927d |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-04-25T01:22:13Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-2e4fad07104f48e1b456183c6b20927d2024-03-09T09:25:39ZengElsevierHeliyon2405-84402024-02-01104e25631Pregnancy, delivery and neonatal outcomes in women with a cerebrovascular-accident history prior to delivery - Evaluation of a population databaseUri Amikam0Ahmad Badeghiesh1Haitham Baghlaf2Richard Brown3Michael H. Dahan4Department of Obstetrics and Gynecology, McGill University, Montréal, Quebec, Canada; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Corresponding author. Department of Obstetrics and Gynecology McGill University, 845 Rue Sherbrooke, O, Montreal, QC, 3HA 0G4, Canada.Department of Obstetrics and Gynecology, King Abdulaziz University, Rabigh Branch, Rabigh, Saudi ArabiaDepartment of Obstetrics and Gynecology, University of Tabuk, Tabuk, Saudi ArabiaDepartment of Obstetrics and Gynecology, McGill University, Montréal, Quebec, CanadaDepartment of Obstetrics and Gynecology, McGill University, Montréal, Quebec, CanadaObjective: Cerebrovascular accidents (CVA) in childbearing-age women are rare. We aimed to evaluate the association between CVA events prior to delivery and obstetrical and neonatal outcomes. Methods: A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP–NIS) database. All pregnant women who delivered or had a maternal death in the US from 2004 to 2014 were included in the study. We performed a comparison between women with an ICD-9 diagnosis of CVA before the delivery admission and those without. Obstetrical and neonatal outcomes were compared between the two groups. Results: In total, 9,096,788 women fulfilled the inclusion criteria. Among them, 695 women (7.6 per 100,000) were diagnosed with a CVA before delivery. Women with a history of CVA, compared to those without, were more likely to be Black, older than 35 years of age, and suffer from obesity, chronic hypertension, pregestational diabetes, and thyroid disease. Patients with a prior CVA, compared to those without, had higher rates of pregnancy-induced hypertension (aOR 6.41, 95% CI 5.03–8.39, p < 0.001), preeclampsia (aOR 7.65, 95% CI 6.03–9.71, p < 0.001), and eclampsia (aOR 171.56, 95% CI 124.63–236.15, p < 0.001). Additionally, they had higher rates of preterm delivery (aOR 1.72, 95% CI 1.33–2.22,p = 0.003), cesarean section (aOR 2.69, 95% CI 2.15–3.37, p < 0.001), and maternal complications such as a peripartum hysterectomy (aOR 11.62, 95% CI 5.77–23.41, p < 0.001), postpartum hemorrhage (aOR 3.39, 95 % CI 2.52–4.54, p < 0.001), disseminated intravascular coagulation (aOR 16.32, 95% CI 11.33–23.52, p < 0.001), venous thromboembolism (aOR 45.08, 95% CI 27.17–74.8, p < 0.001), and maternal death (aOR 486.11, 95% CI 307.26–769.07, p < 0.001). Regarding neonatal outcomes, patients with a prior CVA, compared to those without, had a higher rate of intrauterine fetal demise and congenital anomalies. Conclusion: Women with a CVA event before delivery have a significantly higher incidence of maternal complications, including hypertensive disorders of pregnancy, and neonatal complications, such as intrauterine fetal demise and congenital anomalies. Rates of maternal death were dramatically increased, and this association requires further evaluation.http://www.sciencedirect.com/science/article/pii/S2405844024016621 |
| spellingShingle | Uri Amikam Ahmad Badeghiesh Haitham Baghlaf Richard Brown Michael H. Dahan Pregnancy, delivery and neonatal outcomes in women with a cerebrovascular-accident history prior to delivery - Evaluation of a population database Heliyon |
| title | Pregnancy, delivery and neonatal outcomes in women with a cerebrovascular-accident history prior to delivery - Evaluation of a population database |
| title_full | Pregnancy, delivery and neonatal outcomes in women with a cerebrovascular-accident history prior to delivery - Evaluation of a population database |
| title_fullStr | Pregnancy, delivery and neonatal outcomes in women with a cerebrovascular-accident history prior to delivery - Evaluation of a population database |
| title_full_unstemmed | Pregnancy, delivery and neonatal outcomes in women with a cerebrovascular-accident history prior to delivery - Evaluation of a population database |
| title_short | Pregnancy, delivery and neonatal outcomes in women with a cerebrovascular-accident history prior to delivery - Evaluation of a population database |
| title_sort | pregnancy delivery and neonatal outcomes in women with a cerebrovascular accident history prior to delivery evaluation of a population database |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024016621 |
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