Pregnancy and the Risk of Aortic Dissection or Rupture

Aug 10, 2016
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Authors:
Kamel H, Roman MJ, Pitcher A, Devereux RB.
Citation:
Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis. Circulation 2016;Aug 4:[Epub ahead of print].
Summary By:
David S. Bach, MD, FACC

Study Questions:

Is there an association between pregnancy and increased risk of aortic dissection or rupture?

Methods:

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.

Results:

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.

Conclusions:

The authors concluded that the risk of aortic dissection or rupture is increased during pregnancy and the post-partum interval.

Perspective:

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.

Keywords: Aneurysm, Dissecting, Aortic Aneurysm, Aortic Rupture, Delivery, Obstetric, Emergency Service, Hospital, Labor, Obstetric, Postpartum Period, Pregnancy, Pregnancy Outcome, Risk Assessment, Secondary Prevention, Vascular Diseases


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