Aortic Dissection During Pregnancy and Puerperium: Contemporary Incidence and Outcomes in the United States

Abstract

Background Aortic dissection (AD) during pregnancy and puerperium is a rare catastrophe with devastating consequences for both parent and fetus. Population‐level incidence trends and outcomes remain relatively undetermined. Methods and Results We queried a US population‐based health care database, the National Inpatient Sample, and identified all patients with a pregnancy‐related AD hospitalization from 2002 to 2017. In total, 472 pregnancy‐related AD hospitalizations (mean age, 30.9±0.6 years) were identified from 68 514 000 pregnancy‐related hospitalizations (0.69 per 100 000 pregnancy‐related hospitalizations), with 107 (22.7%) being type A and 365 (77.3%) being type B. The incidence of AD appeared to increase over the 16‐year study period but was not statistically significant ( P for trend >0.05). Marfan syndrome, primary hypertension, and preeclampsia/eclampsia were found in 21.9%, 14.4%, and 11.5%, respectively. On multivariable logistic regression analysis, Marfan syndrome was associated with the highest risk of developing AD during pregnancy and puerperium (adjusted odds ratio, 3469.36 [95% CI, 1767.84–6831.75]; P <0.001). The in‐hospital mortalities of AD, type A AD, and type B AD were 7.3%, 4.3%, and 8.1%, respectively. Length of hospital stay for the AD, type A AD, and type B AD groups were 7.7±0.8, 10.4±1.9, and 6.9±0.9 days, respectively. Conclusions We quantified population‐level incidence and in‐hospital mortality in the United States and observed an increase in the incidence of pregnancy‐related AD. In contrast, its in‐hospital mortality appears lower than that of non–pregnancy‐related AD.