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Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis.

TitlePregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis.
Publication TypeJournal Article
Year of Publication2016
AuthorsKamel H, Roman MJ, Pitcher A, Devereux RB
JournalCirculation
Volume134
Issue7
Pagination527-33
Date Published2016 Aug 16
ISSN1524-4539
KeywordsAdult, Aneurysm, Dissecting, Aortic Rupture, Cohort Studies, Cross-Over Studies, Female, Humans, Pregnancy, Pregnancy Complications, Cardiovascular, Risk Factors, Young Adult
Abstract

BACKGROUND: Case series have described aortic dissection and rupture in pregnancy. Few population-based data exist to support an association.

METHODS: We performed a cohort-crossover study using data on all emergency department visits and acute care hospitalizations at nonfederal healthcare facilities in California, Florida, and New York. We included women ≥12 years of age with labor and delivery or abortive pregnancy outcome between 2005 and 2013. Our outcome was a composite of aortic dissection or rupture. Based on the timing of reported aortic complications during pregnancy, we defined the period of risk as 6 months before delivery until 3 months after delivery. We compared each patient's likelihood of aortic complications during this period with an equivalent 270-day period exactly 1 year later. Incidence rates and incidence rate ratios were computed using conditional Poisson regression with robust standard errors.

RESULTS: Among 6 566 826 pregnancies in 4 933 697 women, we identified 36 cases of aortic dissection or rupture during the pregnancy or postpartum period and 9 cases during the control period 1 year later. The rate of aortic complications was 5.5 (95% confidence interval, 4.0-7.8) per million patients during pregnancy and the postpartum period, in comparison with 1.4 (95% confidence interval, 0.7-2.9) per million during the equivalent period 1 year later. Pregnancy was associated with a significantly increased risk of aortic dissection or rupture (incidence rate ratio, 4.0; 95% confidence interval, 2.0-8.2) in comparison with the control period 1 year later.

CONCLUSIONS: The risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period.

DOI10.1161/CIRCULATIONAHA.116.021594
Alternate JournalCirculation
PubMed ID27492904
PubMed Central IDPMC4987245
Grant ListFS/08/077/26366 / / British Heart Foundation / United Kingdom
K23 NS082367 / NS / NINDS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States