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Abstract：
BACKGROUND: Intracerebral hemorrhage (ICH) is a major cause of maternal morbidity, but its pathophysiology is poorly characterized. We investigated characteristics of pregnancy-associated ICH (P-ICH), compared with ICH in similar aged nonpregnant adults of both sexes.
RESULTS: We performed a retrospective analysis of 134 adults aged 18 to 44 years admitted to our center with nontraumatic ICH from January 1, 2012, to December 31, 2021. We compared ICH characteristics among 3 groups: those with P-ICH (pregnant or within 12 months of end of pregnancy); nonpregnant women; and men. We categorized ICH pathogenesis according to a modified scheme, SMASH-UP (structural, medications, amyloid angiopathy, systemic, hypertension, undetermined, posterior reversible encephalopathy syndrome/reversible cerebral vasoconstriction syndrome), and calculated odds ratios and 95% CIs for primary (spontaneous small-vessel) ICH versus secondary ICH (structural lesions or coagulopathy related), using nonpregnant women as the reference. We also compared specific ICH pathogenesis by SMASH-UP criteria and functional outcomes between groups. Of 134 young adults with nontraumatic ICH, 25 (19%) had P-ICH, of which 60% occurred postpartum. Those with P-ICH had higher odds of primary ICH compared with nonpregnant women (adjusted odds ratio, 4.5 [95% CI, 1.4-14.7]). The odds of primary ICH did not differ between men and nonpregnant women. SMASH-UP pathogenesis for ICH differed significantly between groups (P<0.001). While the in-hospital mortality rate was lowest in the P-ICH group (4%) compared with nonpregnant women (13%) and men (24%), 1 in 4 patients with P-ICH were bedbound and dependent at the time of discharge.
CONCLUSIONS: In our cohort of young adults with ICH, 1 in 5 was pregnancy related. P-ICH differed in pathogenesis compared with non-pregnancy-related ICH in young adults, suggesting unique pathophysiology.
RESULTS: We performed a retrospective analysis of 134 adults aged 18 to 44 years admitted to our center with nontraumatic ICH from January 1, 2012, to December 31, 2021. We compared ICH characteristics among 3 groups: those with P-ICH (pregnant or within 12 months of end of pregnancy); nonpregnant women; and men. We categorized ICH pathogenesis according to a modified scheme, SMASH-UP (structural, medications, amyloid angiopathy, systemic, hypertension, undetermined, posterior reversible encephalopathy syndrome/reversible cerebral vasoconstriction syndrome), and calculated odds ratios and 95% CIs for primary (spontaneous small-vessel) ICH versus secondary ICH (structural lesions or coagulopathy related), using nonpregnant women as the reference. We also compared specific ICH pathogenesis by SMASH-UP criteria and functional outcomes between groups. Of 134 young adults with nontraumatic ICH, 25 (19%) had P-ICH, of which 60% occurred postpartum. Those with P-ICH had higher odds of primary ICH compared with nonpregnant women (adjusted odds ratio, 4.5 [95% CI, 1.4-14.7]). The odds of primary ICH did not differ between men and nonpregnant women. SMASH-UP pathogenesis for ICH differed significantly between groups (P<0.001). While the in-hospital mortality rate was lowest in the P-ICH group (4%) compared with nonpregnant women (13%) and men (24%), 1 in 4 patients with P-ICH were bedbound and dependent at the time of discharge.
CONCLUSIONS: In our cohort of young adults with ICH, 1 in 5 was pregnancy related. P-ICH differed in pathogenesis compared with non-pregnancy-related ICH in young adults, suggesting unique pathophysiology.
摘要：
背景：脑出血（ICH）是孕产妇发病的主要原因，但是它的病理生理学特征很差。我们调查了妊娠相关ICH（P-ICH）的特征，与年龄相似的非妊娠成人的ICH相比。
结果：我们对2012年1月1日至2021年12月31日入住我们中心的134名18至44岁非创伤性ICH患者进行了回顾性分析。我们比较了3组的ICH特征：P-ICH患者（妊娠或妊娠结束后12个月内）；非妊娠妇女；和男性。我们根据改良方案对ICH发病机制进行了分类，SMASH-UP(结构性，药物,淀粉样血管病,系统性，高血压,未确定,后部可逆性脑病综合征/可逆性脑血管收缩综合征），原发性(自发性小血管)ICH与继发性ICH(结构性病变或凝血病相关)的比值比和95%CI，使用非孕妇作为参考。我们还通过SMASH-UP标准比较了具体的ICH发病机制和组间的功能结果。在134名患有非创伤性ICH的年轻人中，25（19%）患有P-ICH，其中60%发生在产后。与未怀孕的女性相比，患有P-ICH的女性患原发性ICH的几率更高(调整后的优势比，4.5[95%CI，1.4-14.7]）。原发性ICH的几率在男性和未怀孕的女性之间没有差异。SMASH-UP对ICH的发病机制在组间有显著差异(P<0.001)。虽然P-ICH组的住院死亡率最低（4%），但与未怀孕的女性（13%）和男性（24%）相比，4例P-ICH患者中有1例在出院时卧床并依赖。
结论：在我们的年轻成人ICH队列中，1/5与妊娠有关。与非妊娠相关的年轻成人ICH相比，P-ICH的发病机制不同，提示独特的病理生理学。
结果：我们对2012年1月1日至2021年12月31日入住我们中心的134名18至44岁非创伤性ICH患者进行了回顾性分析。我们比较了3组的ICH特征：P-ICH患者（妊娠或妊娠结束后12个月内）；非妊娠妇女；和男性。我们根据改良方案对ICH发病机制进行了分类，SMASH-UP(结构性，药物,淀粉样血管病,系统性，高血压,未确定,后部可逆性脑病综合征/可逆性脑血管收缩综合征），原发性(自发性小血管)ICH与继发性ICH(结构性病变或凝血病相关)的比值比和95%CI，使用非孕妇作为参考。我们还通过SMASH-UP标准比较了具体的ICH发病机制和组间的功能结果。在134名患有非创伤性ICH的年轻人中，25（19%）患有P-ICH，其中60%发生在产后。与未怀孕的女性相比，患有P-ICH的女性患原发性ICH的几率更高(调整后的优势比，4.5[95%CI，1.4-14.7]）。原发性ICH的几率在男性和未怀孕的女性之间没有差异。SMASH-UP对ICH的发病机制在组间有显著差异(P<0.001)。虽然P-ICH组的住院死亡率最低（4%），但与未怀孕的女性（13%）和男性（24%）相比，4例P-ICH患者中有1例在出院时卧床并依赖。
结论：在我们的年轻成人ICH队列中，1/5与妊娠有关。与非妊娠相关的年轻成人ICH相比，P-ICH的发病机制不同，提示独特的病理生理学。
