(738) Trends and Outcomes Among Racial and Ethnic Groups in Pregnancy Associated Stroke

Objective: To compare trends of pregnancy associated stroke (PAS), risk factors, and adverse maternal outcomes among racial and ethnic groups.

Study Design: This was a retrospective cross-sectional study of the National Inpatient Sample to identify hospitalizations with PAS in the U.S. (2016-2020). The inclusion criteria was PAS at any time. Race and ethnicity were categorized as non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Other. We excluded those with unknown race/ethnicity. Demographics, clinical characteristics and adverse maternal outcomes (mechanical ventilation, seizure, pneumonia, prolonged hospital stay [ > 7 days] and in hospital mortality) were compared among racial and ethnic groups. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risk (aRR) and 95% confidence interval (CI). Annual percent change (APC) was calculated to assess changes in rates of PAS over time.

Results: Among 19,717,450 pregnancy hospitalizations, 7,815 hospitalizations (0.04%) had pregnancy associated stroke. Of these, 3,390 (45.4%) identified as Non-Hispanic White, 1,865 (25%) as Non-Hispanic Black, 1,400 (18.8%) as Hispanic, 810 (10.9%) as Non-Hispanic Other race and 350 (0.4%) were excluded given unknown race/ethnicity. The groups differed in age, primary payer, smoking status, location and teaching status of hospital, and region of hospital. Non-Hispanic Black PAS were more likely to have body mass index ≥ 30, diabetes, sickle cell disease, hypertensive disorder of pregnancy, and have postpartum stroke. After adjustment, there was no significant difference in the risk of in-hospital mortality, prolonged hospital stay, or mechanical ventilation. However, there was a higher risk in seizure in non–Hispanic Other group and pneumonia in non-Hispanic Black (Table). The rate of PAS remained stable over the 5-year analysis period in all racial and ethnic groups.

Conclusion: A nationally representative sample of hospitalizations in the U.S. indicates racial and ethnic differences in the risk of some adverse outcomes related to pregnancy associated stroke.