Department of Neurology, Stroke Division Columbia University New York NY.
Department of Neurology, Neurocritical Care Division Columbia University New York NY.
J Am Heart Assoc. 2024 Apr 2;13(7):e034032. doi: 10.1161/JAHA.123.034032. Epub 2024 Mar 27.
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.
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 (<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.
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.
脑出血（ICH）是产妇发病率的主要原因，但对其病理生理学的认识尚不清楚。我们研究了与妊娠相关的脑出血（P-ICH）的特征，并将其与同期相同年龄的非妊娠成年男女的 ICH 进行了比较。
我们对 2012 年 1 月 1 日至 2021 年 12 月 31 日期间因非外伤性 ICH 入住我们中心的 134 名 18 至 44 岁的成年人进行了回顾性分析。我们比较了三组 ICH 特征：有 P-ICH（怀孕或怀孕结束后 12 个月内）的患者；非妊娠妇女；和男性。我们根据改良方案 SMASH-UP（结构、药物、淀粉样血管病、全身性、高血压、未确定、后部可逆性脑病综合征/可逆性脑动脉收缩综合征）对 ICH 发病机制进行分类，并使用非妊娠妇女作为参考，计算原发性（自发性小血管）ICH 与继发性 ICH（结构病变或凝血障碍相关）的优势比（OR）及其 95%置信区间（CI）。我们还比较了按 SMASH-UP 标准和各组之间的功能结局的特定 ICH 发病机制。在 134 名患有非外伤性 ICH 的年轻成年人中，有 25 名（19%）患有 P-ICH，其中 60%发生在产后。与非妊娠妇女相比，患有 P-ICH 的患者发生原发性 ICH 的可能性更高（调整后的 OR，4.5 [95%CI，1.4-14.7]）。男性与非妊娠妇女发生原发性 ICH 的可能性没有差异。各组之间的 ICH 发病机制明显不同（<0.001）。尽管 P-ICH 组的住院死亡率最低（4%），而非妊娠妇女组（13%）和男性组（24%），但仍有 1/4 的 P-ICH 患者在出院时卧床不起且依赖他人。
在我们的年轻 ICH 患者队列中，有 1/5 与妊娠有关。与年轻非妊娠相关 ICH 相比，P-ICH 在发病机制上存在差异，提示存在独特的病理生理学。
