Abstract 36: Secular Increases in Spontaneous Subarachnoid Hemorrhage during Pregnancy

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Abstract

Introduction: Our understanding of the epidemiology, outcomes and management of spontaneous subarachnoid hemorrhage (sSAH) in pregnancy is limited by small, single center series, which suggest a slightly higher morbidity and mortality. Larger population studies are needed to accurately estimate the risk of sSAH during pregnancy, and the associated morbidity and mortality.

Methods: A retrospective analysis was performed utilizing the Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project for the years 2002–2014. NIS is one of the largest administrative database and is designed to produce nationally weighted estimates. Female patients age 15-49 with spontaneous subarachnoid hemorrhage were identified with International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 430.Pregnancy and maternal diagnosis were identified using pregnancy related ICD codes validated by previous studies. Cochran-Armitage trend test and parametric tests were utilized to analyze temporal trends and group comparisons.

Results: There were 73,692 admissions for sSAH occurred in women age group of 15-49 years from 2002-14, of which 3,978 (5.4%) were in pregnant women. Over the 12 years of study period, proportion of sSAH during pregnancy increased from 4.16 % to 6.33% {p-trend <0.001} whereas in non-pregnant women has slightly reduced. In the study cohort, African American women had higher proportion of sSAH during pregnancy (8.19%) followed by Hispanic (7.11%) as compare to Caucasian (3.83%) women. Proportion of sSAH during pregnancy was highest in age group 20-29 years (20.07%) as compared to age 15-19 years (11.39 %), 30-39 years (10.01%) and age 40-49 (0.69%). sSAH during pregnancy had less in-hospital mortality as compare to non-pregnant women with sSAH (7.7% vs 17.4%; p:<0.001) in age controlled cohort and had higher discharge to home as compare to non-pregnant women with sSAH (69.87% vs 53.85% %; p:<0.001).

Conclusion: There is an upward trend in the pregnancy related spontaneous SAH from 2002 to 2014. African American race and 20-29 years’ age group have higher preponderance of pregnancy related spontaneous SAH. Clinical outcomes of spontaneous SAH in pregnant women were better than in non-pregnant women.

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