Pregnancy and the Risk of Aortic Dissection or Rupture
Is there an association between pregnancy and increased risk of aortic dissection or rupture?
A cohort-crossover study was performed using data on all emergency department visits and acute care hospitalizations at nonfederal health care facilities in California, Florida, and New York; including women ≥12 years of age with labor and delivery or abortive pregnancy outcome between 2005 and 2013. The measured outcome was a composite of aortic dissection or rupture occurring from 6 months before delivery until 3 months after delivery. Each patient’s likelihood of aortic complications during this period was compared to an equivalent 270-day period exactly 1 year later. Incidence rates and incidence rate ratios were computed using conditional Poisson regression.
Among 6,566,826 pregnancies in 4,933,697 women, 36 cases of aortic dissection or rupture were identified during the pregnancy or the post-partum interval, and 9 cases were identified during the control interval 1 year later. The rate of aortic complications was 5.5 (95% confidence interval [CI], 4.0-7.8) per million patients during pregnancy or the post-partum interval, compared with 1.4 (95% CI, 0.7-2.9) per million during the equivalent interval 1 year later. Pregnancy was associated with a significantly increased risk of aortic dissection or rupture (incidence ratio, 4.0; 95% CI, 2.0-8.2) compared with a control period 1 year later.
The authors concluded that the risk of aortic dissection or rupture is increased during pregnancy and the post-partum interval.
Case series have described aortic dissection and rupture in pregnancy. This large cohort-crossover study provides confirmatory data, suggesting that there is approximately a four-fold increased risk of aortic dissection or rupture during pregnancy or the post-partum period compared to a similar interval 1 year later.
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