Abstract Details

Title Risk of Intracerebral Hemorrhage in Pregnancy and the Postpartum Period: A Population Based Analysis using a Cohort–Cross Over Design

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S15 - Intracerebral Hemorrhage and SAH (1:11 PM-1:22 PM)

Poster/Presentation
Number 002

Background While there is a documented increased risk of thrombotic events; little is known regarding the risk of ICH during PP.

Objective To explore the risk of intracerebral hemorrhage (ICH) in pregnancy and postpartum period (PP) utilizing a cohort crossover design in which patients serve as their own control.

Design/Methods We utilized State Inpatient Databases for NY, FL (2005 – 2014) and CA (2005 – 2011), and identified patients with labor/delivery diagnoses using validated ICD-9 codes. The cohort crossover design included a 64wk case period (40wk pregnancy/labor/delivery, 24wk postpartum), followed by a 52wk interim period, and a 64wk crossover period. We excluded patients who were ≤ 12yr, missing linkage information, admitted for false labor, or had prior ICH. We compared the rate of ICH during case and crossover periods and report absolute risk difference and rate ratio with 95% confidence interval (CI) estimated using conditional Poisson regression.

Results

Over 3.3 million deliveries were identified, with 238 patients experiencing ICH during the case period. Those who died during the case / interim period or were in PP during the crossover period were removed from analyses. The overall rate of ICH during case vs. crossover was 8.1 vs 2.5 per 100,000 deliveries / patients, resulting in an absolute risk difference and rate ratio (CI) of 5.5 (4.3 – 6.8) and 3.2 (2.4 – 4.2) respectively. During the case period, the majority of ICH occurred during the 3^rd trimester and first 12wks postpartum. Patients experiencing ICH during PP were more likely to be Black or Asian (compared to White), and had a history of hypertension, diabetes, coagulopathy, thrombocytopenia, substance abuse, or preeclampsia/eclampsia.

Conclusions Pregnancy confers a significantly higher risk of ICH that peaks during the 3^rd trimester and continues into early postpartum. Further investigation is warranted to characterize individuals at a greater risk of ICH during PP.

Authors/Disclosures
Jennifer Meeks PRESENTER	No disclosure on file
	No disclosure on file
Katie Alex (University of Texas Health Science Center At Houston)	No disclosure on file
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist)	Dr. Vahidy has nothing to disclose.

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