Abstract Details

Title Maternal morbidity outcomes in idiopathic moyamoya syndrome in New York State

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S52 - Acute Non-Interventional Stroke Care (4:36 PM-4:47 PM)

Poster/Presentation
Number 007

Background Pregnancy is associated with an increased risk of stroke in young women. IMMS is a rare condition characterized by progressive narrowing of large cerebral arteries resulting flimsy collaterals prone to rupture or thrombosis. Data are limited on pregnancy outcomes in women with IMMS.

Objective To determine if idiopathic moyamoya syndrome (IMMS) is associated with increased pregnancy morbidity.

Design/Methods

Using the NYSDOH SPARCS data from 2000-2014 we identified all women 18 and older with diagnoses of IMMS (ICD-9 437.5) who had hospitalizations for delivery at any time either prior, concomitant or subsequent to IMMS diagnosis. We considered a pregnancy to be IMMS-exposed if it occurred ≤ 3 years prior to, or after, IMMS diagnosis. Pregnancy morbidity was admission within 1 year of delivery for any of the CDC’s severe maternal morbidity indicators, including stroke. We compared the morbidity of IMMS-exposed pregnancies to unexposed pregnancies occurring in the same cohort >3 years prior to IMMS diagnosis. Conditional logistic regression was used to calculate odds ratio (OR) and 95% confidence intervals (95%CI) as well as adjust for women with both exposed and unexposed pregnancies.

Results We identified 134 patients with IMMS, with 117 exposed pregnancies and 147 unexposed pregnancies. Severe maternal morbidity was higher for exposed pregnancies (33.3% vs 19.0%, OR: 2.1, 95%CI: 1.2-3.7). After adjusting for maternal morbidity, exposed pregnancies had more caesarean sections (44.4% vs 23.0%, OR: 4.2, 95%CI: 2.3-7.6). Exposed pregnancies experienced more: stroke, acute myocardial infarction, cardiac arrest, conversion of cardiac rhythm, eclampsia (10.3% vs 4.15, p=0.05), pulmonary edema (9.4% vs 3.4%, p=0.07), and adult respiratory distress syndrome (10.3% vs 4.1%, p=0.05).

Conclusions Pregnancies within 3 years prior or any time after IMMS diagnosis had increased maternal morbidity within 1 year of delivery. Prospective studies are needed to better characterize increased maternal risks for women with moyamoya syndrome and develop preventive strategies.

Authors/Disclosures
Hajere Gatollari PRESENTER	No disclosure on file
Amelia K. Boehme, PhD (Columbia University)	Dr. Boehme has nothing to disclose.
	No disclosure on file
	No disclosure on file
Mitchell S. Elkind, MD, MS, FAAN	Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy.
Joshua Z. Willey, MD (Columbia University)	Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edwards Scientific. Dr. Willey has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for RECARDIO. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BrainQ. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Uptodate. The institution of Dr. Willey has received research support from NIH. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Review chapter author, MKSAP 16-20 with American College of Physicians.
Eliza C. Miller, MD (Columbia University Dept of Neurology)	Dr. Miller has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medical malpractice cases. The institution of Dr. Miller has received research support from National Institutes of Health. Dr. Miller has a non-compensated relationship as a member of ASA Advisory Council with American Heart Association/American Stroke Association that is relevant to AAN interests or activities.

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