Original Research|Articles in Press, 100864

Postpartum Stroke Trends, Risk Factors, and Associated Adverse Outcomes

Published:February 12, 2023DOI:



      Management of postpartum stroke has been the focus of several quality improvement efforts in the past decade. However, there is little recent national trends data for postpartum stroke readmissions.


      To determine trends, risk factors, and complications associated with postpartum stroke readmission.


      The 2013-2019 Nationwide Readmissions Database was used to perform a retrospective cohort study evaluating risk for readmission for stroke within 60 days of delivery hospitalization discharge. Temporal trends in readmissions were analyzed using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change (AAPC) with 95% CIs. Stratified trends were analyzed for hemorrhage stroke, ischemic stroke, and stroke readmissions 1-10, 11-30, and 31-60 days after delivery discharge. Risk factors for stroke were analyzed with unadjusted and adjusted logistic regression models with odds ratios (ORs) with 95% CIs as measures of association. Risk for stroke complications was analyzed including mechanical ventilation, seizures, death, and prolonged stay ≥14 days.


      Of an estimated 21,754,603 delivery hospitalizations, 5,006 were complicated by a 60-day postpartum readmission with a diagnosis of stroke. The average annual percent change for all stroke readmissions over the study period was not significant (AAPC 0.1%, 95% CI -2.2%, 2.4%). When trends in readmission for ischemic and hemorrhagic stroke were analyzed, results were similar as were stratified analyses by readmission timing. Risk factors associated with increased odds included superimposed preeclampsia (OR 4.8, 95% CI 3.9, 5.9), preeclampsia with severe features (OR 3.7, 95% CI 3.0, 4.4), maternal cardiac disease (OR 3.0, 95% CI 2.5, 3.7), chronic kidney disease (OR 5.0, 95% CI 3.4, 7.5), and lupus (OR 7.0, 95% CI 4.9, 10.2). Risk was retained in adjusted analyses. Common stroke-related complications included prolonged hospital stay ≥14 days (12.1 per 1000 stroke-related readmissions), seizures (9.9 per 1000 stroke-related readmissions), and mechanical ventilation (6.6 per 1,000 stroke-related readmissions).


      This analysis of nationally representative data demonstrated no change in the rate of 60-day postpartum hospitalizations with stroke from 2013 to 2019. Further clinical research is indicated to optimize risk reduction for stroke after delivery hospitalization discharge.


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