Preliminary data from a retrospective study presented at the American Stroke Association’s International Stroke Conference 2018 suggest that incidence of spontaneous subarachnoid hemorrhage (sSAH) may be increasing among pregnant women. An abnormality in the brain’s arteries that weakens the vessels, sSAH eventually leads to rupture of the blood vessels, causing hemorrhaging between the brain’s membranes.
For the analysis, the authors looked at data from the Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project for 2012 to 2014. NIS is one the largest administrative databases and designed to produce nationally weighted estimates. Records of women aged 15 to 49 years with sSAH were identified as were pregnancy and maternal diagnosis. Temporal trends and group comparisons were analyzed using Cochran-Armitrage trend and parametric tests.
From the NIS database, the authors identified 73,692 admissions for sSAH, 3978 of which were in pregnant women aged 15 to 49. The researchers discovered that over the 12 years of the study period, the proportion of sSAH occurring during pregnancy increased from 4.16% to 6.33% (P for trend <0.001) whereas rates slightly declined in women who were not pregnant. Among the patients studied, the proportion of sSAH during pregnancy was highest among African-Americans (8.19%) followed by Hispanics (7.11%) versus white women (3.83%). Looking at age, the researcher found that the proportion of sSAH during pregnancy was highest among those women with sSAH aged 20 to 29 (20.07%) versus 11.39% for those aged 15 to 19, 10.01% for aged 30 to 39, and 0.69% for women aged 40 to 49. Rates of in-hospital death were lower for sSAH during pregnancy than in women who were not pregnant (7.7% vs 17.4%; P<0.001) and rates of discharge to home were also higher in pregnant than in non-pregnant women (69.87% vs 53.85%; P < 0.001)
The authors noted a few limitations to their study. The entirety of the data used came from one national database that provides estimates of patients’ hospital stays. It does not, however, provide information on stroke severity. The researchers also said it’s possible that the database included cases that were misdiagnosed as a stroke. They recognize that more research is necessary but believe it important that physicians are aware of the increasing numbers in order to help provide proper care for patients with sSAH.