Cerebrovascular Diagnoses During First Recorded Pregnancies in a 17-Year Period-A Nationwide Analysis of Healthcare Administrative Records Between 2004 and 2020 in a Central-Eastern European Population.

INTRODUCTION: Cerebrovascular disorders are major contributors to maternal morbidity and mortality during pregnancy. In this nationwide study in Hungary, we evaluated the frequency of cerebrovascular diagnoses during first recorded pregnancies in a 17-year period.

MATERIAL AND METHODS: In the framework of the NEUROHUN project utilising nationwide administrative healthcare data, we included women with at least one delivery and with at least one cerebrovascular diagnosis during their first pregnancies recorded between 2004 and 2020. To minimise the number of misclassified first pregnancies due to database limitations appearing towards the beginning of the database, trend analyses using linear regression models were restricted to the 2011-2020 period.

RESULTS: During first recorded pregnancies in the 17-year study time frame (n = 952,451), the frequency of ICD-10 cerebrovascular diagnoses was 0.17% (n = 1614), with an estimated overall prevalence rate of 169.4 per 100,000 women (95% CI: 161.4-177.9). Transient ischaemic attack (TIA) was the most prevalent specific diagnosis, with a rate of 72.7 per 100,000 (95% CI: 67.4-78.3). In a multiple linear regression model on the mean age at first recorded birth within 2004-2020, women diagnosed with a cerebrovascular disorder were, on average, 1.935 years older at the time of their first birth compared to those without a diagnosis (mean difference: 1.935 years; 95% CI [1.188-2.682], p < 0.001). This analysis, adjusted for calendar year trends between 2011 and 2020, suggests that higher maternal age is an important factor associated with these events. In a sensitivity analysis of the linear regression using the diagnoses of G45, I60, I61, I63, and I67 we found that the relationship between the presence of diagnosis and mean age remained significant in the case of G45, I63 and I67, but not for I60 and I61. In the logistic regression model, compared to the reference group of women < 25 years, the prevalence for all evaluable cerebrovascular diagnoses was significantly higher in the >34 age group, and was also significantly higher for TIA (G45) and cerebral infarction (I63) diagnoses in the 25-34 age group. The rate of cerebral infarction among cerebrovascular disorders showed an increasing trend towards higher maternal age (<25 years age group: 12%; 25-34 years age group: 16.5%; >34 years age group: 20.0%). Also, when compared to the reference category of diagnosed women < 25 years, the increase in the odds of cerebral infarction was significant at the 5% level among women > 34 years. In contrast, there was no increment in the proportion of intracranial bleedings at older age.

DISCUSSION AND CONCLUSION: The prevalence of most cerebrovascular diagnoses increases significantly with higher maternal age. Allowing for the limitations of our study, we found that in a Central-Eastern European population, the prevalence of cerebrovascular diagnoses during first recorded pregnancies between 2004 and 2020 was 169.4 per 100,000 (0.17%), with TIA being the most common diagnosis in approximately one-third of cases. The rate of cerebral infarctions among cerebrovascular diagnoses was almost twice as high in those over 34 years of age compared to those below 25. The frequency of pregnancy-related ischemic strokes and cerebral haemorrhages in the Central-Eastern European population corresponds to published values.