title: Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis.
abstract: Case series have described aortic dissection and rupture in pregnancy. Few population-based data exist to support an association.
  
  
  
  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.
  
  
  
  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.
  
  
  
  The risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period.
authors: From Department of Neurology (H.K.), Feil Family Brain and Mind Research Institute (H.K.), and Division of Cardiology M.J.R., R.B.D.), Weill Cornell Medicine, New York, NY; and Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (A.P.). hok9010@med.cornell.edu.
authors: Hooman
authors: H
authors: Kamel
authors: From Department of Neurology (H.K.), Feil Family Brain and Mind Research Institute (H.K.), and Division of Cardiology M.J.R., R.B.D.), Weill Cornell Medicine, New York, NY; and Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (A.P.).
authors: Mary J
authors: MJ
authors: Roman
authors: From Department of Neurology (H.K.), Feil Family Brain and Mind Research Institute (H.K.), and Division of Cardiology M.J.R., R.B.D.), Weill Cornell Medicine, New York, NY; and Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (A.P.).
authors: Alex
authors: A
authors: Pitcher
authors: From Department of Neurology (H.K.), Feil Family Brain and Mind Research Institute (H.K.), and Division of Cardiology M.J.R., R.B.D.), Weill Cornell Medicine, New York, NY; and Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (A.P.).
authors: Richard B
authors: RB
authors: Devereux
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis* / Q000453:epidemiology*; D001019:Aortic Rupture / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D055815:Young Adult
keywords: aneurysm; aorta; pregnancy