title: Hypertensive disorders and pregnancy-related stroke: frequency, trends, risk factors, and outcomes.
abstract: OBJECTIVE
  To evaluate trends and associations of hypertensive disorders of pregnancy with stroke risk and test the hypothesis that hypertensive disorders of pregnancy-associated stroke results in higher rates of stroke-related complications than pregnancy-associated stroke without hypertensive disorders.
  
  
  METHODS
  A cross-sectional study was performed using 81,983,216 pregnancy hospitalizations from the 1994-2011 Nationwide Inpatient Sample. Rates of stroke hospitalizations with and without these hypertensive disorders were reported per 10,000 pregnancy hospitalizations. Using logistic regression, adjusted odds ratios (OR) with 95% confidence intervals were obtained.
  
  
  RESULTS
  Between 1994-1995 and 2010-2011, the nationwide rate of stroke with hypertensive disorders of pregnancy increased from 0.8 to 1.6 per 10,000 pregnancy hospitalizations (103%), whereas the rate without these disorders increased from 2.2 to 3.2 per 10,000 pregnancy hospitalizations (47%). Women with hypertensive disorders of pregnancy were 5.2 times more likely to have a stroke than those without. Having traditional stroke risk factors (eg, congenital heart disease, atrial fibrillation, sickle cell anemia, congenital coagulation defects) substantially increased the stroke risk among hypertensive disorders of pregnancy hospitalizations: from adjusted OR 2.68 for congenital coagulation defects to adjusted OR 13.1 for congenital heart disease. Stroke-related complications were increased in stroke with hypertensive disorders of pregnancy compared with without (from adjusted OR 1.23 for nonroutine discharge to adjusted OR 1.93 for mechanical ventilation).
  
  
  CONCLUSIONS
  Having traditional stroke risk factors substantially increased the stroke risk among hypertensive disorders of pregnancy hospitalizations. Stroke with hypertensive disorders in pregnancy had two distinctive characteristics: a greater increase in frequency since the mid-1990s and significantly higher stroke-related complication rates.
  
  
  METHODS
  III.
authors.affiliation: Obstetric Anesthesia Division, Department of Anesthesia, and Department of Anesthesia, Critical Care & Pain Medicine, and the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Leffert
authors.forename: Caitlin R
authors.initials: CR
authors.lastname: Clancy
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bateman
authors.forename: Allison S
authors.initials: AS
authors.lastname: Bryant
authors.forename: Elena V
authors.initials: EV
authors.lastname: Kuklina
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D001778:Blood Coagulation Disorders / Q000151:congenital / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000151:congenital* / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult