Aortic complications fourfold higher during pregnancy
medwireNews: The risk of aortic dissection or rupture is elevated fourfold during pregnancy and the postpartum period, results of a large, population-based study show.
Patients with hypertension or connective tissue disease were at particularly high risk, Hooman Kamel (Weill Cornell Medicine, New York, USA) and co-researchers report in Circulation.
They say: “These findings can be used to counsel patients at high baseline risk of aortic complications about the risks of pregnancy.”
The study included data on 6,566,826 pregnancies in 4,933,697 women aged 12 years and older who had their labour and delivery (or abortive pregnancy) at nonfederal healthcare facilities in California, Florida and New York between 2005 and 2013.
Among these women, there were 36 cases of aortic dissection or rupture during the 6 months before and 3 months after delivery.
By comparison, there were nine cases, in the same cohort of women, during an equivalent 270-day period exactly 1 year later.
This gave an aortic complication rate of 5.5 per million patients during pregnancy and the postpartum period, compared with 1.4 per million during the equivalent period 1 year later.
Accordingly, pregnancy was associated with a significant fourfold increased risk of aortic dissection or rupture compared with the control period 1 year later.
The researchers note that the risk increase was similar in both the antepartum and postpartum periods, with incidence rate ratios (IRRs) at 4.0 and 3.5, respectively.
Kamel and team also conducted a subanalysis of patients with connective tissue disorders and hypertension, as these have previously been linked to aortic complications during pregnancy.
They found that the absolute rate of aortic dissection or rupture was significantly higher in patients with connective tissue disorder (4960.6 per million) compared with the remaining patients (4.9 per million).
And although patients with and without pre-existing hypertension had similar relative increases in the risk of aortic complications during pregnancy, the absolute risk was elevated in those with hypertension during both the control and pregnancy/postpartum periods, at 42.6 and 106.2 cases per million, respectively.
Kamel et al conclude: “[O]ur findings suggest that clinicians should have a lower threshold for initiating diagnostic testing for symptoms of a possible aortic dissection or rupture in pregnant or postpartum patients—especially those with connective tissue disorders or hypertension—than in nonpregnant women of similar age.”
By Laura Cowen
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