Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH‐UP Criteria
Background Intracerebral hemorrhage (ICH) is a major cause of maternal morbidity, but its pathophysiology is poorly characterized. We investigated characteristics of pregnancy‐associated ICH (P‐ICH), compared with ICH in similar aged nonpregnant adults of both sexes. Methods and Results We performed...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.034032 |
| _version_ | 1827298182012338176 |
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| author | Mehriban Sariyeva Noora Haghighi Amanda Mitchell Whitney A. Booker Nils H. Petersen Andrea D. Shields Shivani Ghoshal Sachin Agarwal Soojin Park Jan Claassen E. Sander Connolly David J. Roh Eliza C. Miller |
| author_facet | Mehriban Sariyeva Noora Haghighi Amanda Mitchell Whitney A. Booker Nils H. Petersen Andrea D. Shields Shivani Ghoshal Sachin Agarwal Soojin Park Jan Claassen E. Sander Connolly David J. Roh Eliza C. Miller |
| author_sort | Mehriban Sariyeva |
| collection | DOAJ |
| description | Background Intracerebral hemorrhage (ICH) is a major cause of maternal morbidity, but its pathophysiology is poorly characterized. We investigated characteristics of pregnancy‐associated ICH (P‐ICH), compared with ICH in similar aged nonpregnant adults of both sexes. Methods and Results We performed a retrospective analysis of 134 adults aged 18 to 44 years admitted to our center with nontraumatic ICH from January 1, 2012, to December 31, 2021. We compared ICH characteristics among 3 groups: those with P‐ICH (pregnant or within 12 months of end of pregnancy); nonpregnant women; and men. We categorized ICH pathogenesis according to a modified scheme, SMASH‐UP (structural, medications, amyloid angiopathy, systemic, hypertension, undetermined, posterior reversible encephalopathy syndrome/reversible cerebral vasoconstriction syndrome), and calculated odds ratios and 95% CIs for primary (spontaneous small‐vessel) ICH versus secondary ICH (structural lesions or coagulopathy related), using nonpregnant women as the reference. We also compared specific ICH pathogenesis by SMASH‐UP criteria and functional outcomes between groups. Of 134 young adults with nontraumatic ICH, 25 (19%) had P‐ICH, of which 60% occurred postpartum. Those with P‐ICH had higher odds of primary ICH compared with nonpregnant women (adjusted odds ratio, 4.5 [95% CI, 1.4–14.7]). The odds of primary ICH did not differ between men and nonpregnant women. SMASH‐UP pathogenesis for ICH differed significantly between groups (P<0.001). While the in‐hospital mortality rate was lowest in the P‐ICH group (4%) compared with nonpregnant women (13%) and men (24%), 1 in 4 patients with P‐ICH were bedbound and dependent at the time of discharge. Conclusions In our cohort of young adults with ICH, 1 in 5 was pregnancy related. P‐ICH differed in pathogenesis compared with non–pregnancy‐related ICH in young adults, suggesting unique pathophysiology. |
| first_indexed | 2024-04-24T15:09:47Z |
| format | Article |
| id | doaj.art-97176443bae64404acef33283201789d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-24T15:09:47Z |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-97176443bae64404acef33283201789d2024-04-02T11:49:51ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-04-0113710.1161/JAHA.123.034032Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH‐UP CriteriaMehriban Sariyeva0Noora Haghighi1Amanda Mitchell2Whitney A. Booker3Nils H. Petersen4Andrea D. Shields5Shivani Ghoshal6Sachin Agarwal7Soojin Park8Jan Claassen9E. Sander Connolly10David J. Roh11Eliza C. Miller12Department of Neurology, Stroke Division Columbia University New York NYDepartment of Neurology, Stroke Division Columbia University New York NYDepartment of Neurology, Neurocritical Care Division Columbia University New York NYDepartment of Obstetrics and Gynecology, Maternal‐Fetal Medicine Division Columbia University New York NYDepartment of Neurology, Neurocritical Care Division Yale University New Haven CTDepartment of Obstetrics and Gynecology, Maternal‐Fetal Medicine Division University of Connecticut Health Hartford CTDepartment of Neurology, Neurocritical Care Division Columbia University New York NYDepartment of Neurology, Neurocritical Care Division Columbia University New York NYDepartment of Neurology, Neurocritical Care Division Columbia University New York NYDepartment of Neurology, Neurocritical Care Division Columbia University New York NYDepartment of Neurosurgery Columbia University New York NYDepartment of Neurology, Neurocritical Care Division Columbia University New York NYDepartment of Neurology, Stroke Division Columbia University New York NYBackground Intracerebral hemorrhage (ICH) is a major cause of maternal morbidity, but its pathophysiology is poorly characterized. We investigated characteristics of pregnancy‐associated ICH (P‐ICH), compared with ICH in similar aged nonpregnant adults of both sexes. Methods and Results We performed a retrospective analysis of 134 adults aged 18 to 44 years admitted to our center with nontraumatic ICH from January 1, 2012, to December 31, 2021. We compared ICH characteristics among 3 groups: those with P‐ICH (pregnant or within 12 months of end of pregnancy); nonpregnant women; and men. We categorized ICH pathogenesis according to a modified scheme, SMASH‐UP (structural, medications, amyloid angiopathy, systemic, hypertension, undetermined, posterior reversible encephalopathy syndrome/reversible cerebral vasoconstriction syndrome), and calculated odds ratios and 95% CIs for primary (spontaneous small‐vessel) ICH versus secondary ICH (structural lesions or coagulopathy related), using nonpregnant women as the reference. We also compared specific ICH pathogenesis by SMASH‐UP criteria and functional outcomes between groups. Of 134 young adults with nontraumatic ICH, 25 (19%) had P‐ICH, of which 60% occurred postpartum. Those with P‐ICH had higher odds of primary ICH compared with nonpregnant women (adjusted odds ratio, 4.5 [95% CI, 1.4–14.7]). The odds of primary ICH did not differ between men and nonpregnant women. SMASH‐UP pathogenesis for ICH differed significantly between groups (P<0.001). While the in‐hospital mortality rate was lowest in the P‐ICH group (4%) compared with nonpregnant women (13%) and men (24%), 1 in 4 patients with P‐ICH were bedbound and dependent at the time of discharge. Conclusions In our cohort of young adults with ICH, 1 in 5 was pregnancy related. P‐ICH differed in pathogenesis compared with non–pregnancy‐related ICH in young adults, suggesting unique pathophysiology.https://www.ahajournals.org/doi/10.1161/JAHA.123.034032intracerebral hemorrhagepostpartumpreeclampsiapregnancysex differencesyoung adults |
| spellingShingle | Mehriban Sariyeva Noora Haghighi Amanda Mitchell Whitney A. Booker Nils H. Petersen Andrea D. Shields Shivani Ghoshal Sachin Agarwal Soojin Park Jan Claassen E. Sander Connolly David J. Roh Eliza C. Miller Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH‐UP Criteria Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease intracerebral hemorrhage postpartum preeclampsia pregnancy sex differences young adults |
| title | Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH‐UP Criteria |
| title_full | Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH‐UP Criteria |
| title_fullStr | Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH‐UP Criteria |
| title_full_unstemmed | Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH‐UP Criteria |
| title_short | Primary and Secondary Intracerebral Hemorrhage in Pregnant and Nonpregnant Young Adults by SMASH‐UP Criteria |
| title_sort | primary and secondary intracerebral hemorrhage in pregnant and nonpregnant young adults by smash up criteria |
| topic | intracerebral hemorrhage postpartum preeclampsia pregnancy sex differences young adults |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.034032 |
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