Work

Postpartum risk and prognosis of pregnancy-associated intracerebral haemorrhage: a nationwide cohort-crossover study

Year: 2026

Type: article

Abstract: Background The temporal pattern and maternal-offspring burden of pregnancy-associated intracerebral haemorrhage (P–ICH), an uncommon but devastating pregnancy-postpartum complication, have not been comprehensively elucidated. Methods This cohort-crossover study linked four nationwide databases to include pregnancies from 2012 to 2020 in Taiwan. Incidence rate ratios (IRRs) for P–ICH were estimated across six intervals from pregnancy through the full 1-year postpartum, with the corresponding period 730 days prior serving as the control. Cohort-time-control and cohort-cohort-time-control sensitivity analyses were performed to adjust for the 730-day age gap. Maternal-offspring outcomes were compared between pregnancies with and without P–ICH. Findings 406 P–ICH events were identified (crude incidence 19·22 per 100,000 pregnancies). The overall IRR was 1·79 (95% CI 1·52–2·10). The P–ICH risk showed no meaningful difference across pregnancy but peaked during 0–42 days postpartum (IRR 7·44; 95% CI 4·55–12·18), remaining elevated through 43–180 days (IRR 1·58; 95% CI 1·13–2·20) and 181–365 days (IRR 1·38; 95% CI 1·04–1·83) postpartum. Postpartum elevations were sustained meaningfully in sensitivity analyses, except the 181–365-day cohort-time-control estimate. Women with HDP other than chronic hypertension showed a greater P–ICH risk than those without (p interaction = 0·0024). Two-year maternal (12·1% vs 0·1%) and offspring (2·2% vs 0·4%) mortality were substantially higher following P–ICH, with 38·8% of maternal deaths in women developing P–ICH 43–365 days postpartum. Interpretation P–ICH imposes a substantial and extended postpartum burden, supporting at least 6-month postpartum surveillance and prevention. Funding National Cheng Kung University Hospital.

Source: The Lancet Regional Health - Western Pacific

DOI: 10.1016/j.lanwpc.2026.102005