title: Acute cerebrovascular disease occurring after hospital discharge for labor and delivery.
abstract: OBJECTIVE
  The risk of stroke and other postpartum cerebrovascular disease (CVD) occurring after hospital discharge for labor and delivery is uncertain.
  
  
  METHODS
  We performed a retrospective cohort study using administrative databases to identify all pregnant women who were hospitalized for labor and delivery at nonfederal, acute care hospitals in California from 2005 to 2011 and who were discharged without an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of CVD. The primary outcome was an acute CVD composite defined as any ischemic stroke, intracranial hemorrhage, cerebral venous sinus thrombosis, pituitary apoplexy, carotid/vertebral artery dissection, hypertensive encephalopathy, or other acute CVD occurring after hospital discharge and before 6 weeks after labor and delivery. Descriptive statistics were used to estimate the incidence of postdischarge CVD. Multivariate logistic regression was used to evaluate the association between selected baseline factors and postdischarge CVD.
  
  
  RESULTS
  The rate of any postdischarge acute CVD was 14.8 per 100 000 patients (95% confidence interval [CI], 13.2-16.5). Risk factors for any acute CVD were eclampsia (odds ratio [OR], 10.1; 95% CI, 3.09-32.8), chronic kidney disease (OR, 5.4; 95% CI, 2.5-11.8), black race (OR, 2.5; 95% CI, 1.9-3.3), preeclampsia (OR, 2.1; 95% CI, 1.6-2.8), pregnancy-related hematologic disorders (OR, 1.8; 95% CI, 1.3-2.5), and age (OR, 1.5 per decade; 95% CI, 1.3-1.8).
  
  
  CONCLUSIONS
  The incidence of postpartum acute CVD after hospital discharge for labor and delivery is similar to rates reported for all postpartum events in previous publications, suggesting that a substantial proportion of postpartum CVD occurs after discharge.
authors.affiliation: From the Department of Neurology (D.A.H., N.S., H.K., M.E.F., B.B.N.) and Brain and Mind Research Institute (H.K., M.E.F., B.B.N.), Weill Cornell Medical College, New York, NY.
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Hovsepian
authors.affiliation: From the Department of Neurology (D.A.H., N.S., H.K., M.E.F., B.B.N.) and Brain and Mind Research Institute (H.K., M.E.F., B.B.N.), Weill Cornell Medical College, New York, NY.
authors.forename: Nandita
authors.initials: N
authors.lastname: Sriram
authors.affiliation: From the Department of Neurology (D.A.H., N.S., H.K., M.E.F., B.B.N.) and Brain and Mind Research Institute (H.K., M.E.F., B.B.N.), Weill Cornell Medical College, New York, NY.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: From the Department of Neurology (D.A.H., N.S., H.K., M.E.F., B.B.N.) and Brain and Mind Research Institute (H.K., M.E.F., B.B.N.), Weill Cornell Medical College, New York, NY.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Fink
authors.affiliation: From the Department of Neurology (D.A.H., N.S., H.K., M.E.F., B.B.N.) and Brain and Mind Research Institute (H.K., M.E.F., B.B.N.), Weill Cornell Medical College, New York, NY. ban9003@med.cornell.edu.
authors.forename: Babak B
authors.initials: BB
authors.lastname: Navi
mesh_terms: D000208:Acute Disease / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D044383:Black People / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D004461:Eclampsia / Q000453:epidemiology; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D015994:Incidence; D010351:Patient Discharge / Q000706:statistics & numerical data; D049590:Postpartum Period; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D001741:Black or African American
keywords: cerebral hemorrhage; postpartum period; pregnancy; stroke