Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis
Background—Case series have described aortic dissection and rupture in pregnancy. Few population-based data exist to support an association.
Methods—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 to 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.
Results—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 [CI], 4.0-7.8) per million patients during pregnancy and the postpartum period, compared with 1.4 (95% CI, 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% CI, 2.0-8.2) compared to the control period 1 year later.
Conclusions—The risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period.
- Received January 18, 2016.
- Revision received May 6, 2016.
- Accepted June 15, 2016.