Postpartum risk and prognosis of pregnancy-associated intracerebral haemorrhage: a nationwide cohort-crossover study
- 1Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 2Population Health Data Center, National Cheng Kung University, Tainan, Taiwan; School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 3Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
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 .
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BibTeX
@article{chen2026postpartum,
title = {{Postpartum risk and prognosis of pregnancy-associated intracerebral haemorrhage: a nationwide cohort-crossover study}},
author = {Yu-Ning Chen and Hao-Hsiang Hsu and Michael Chun-Yuan Cheng and Brian Meng-Hsun Li and Yu Shyr and Edward Chia-Cheng Lai and Chao-Han Lai},
journal = {The Lancet Regional Health. Western Pacific},
year = {2026},
month = oct,
doi = {10.1016/j.lanwpc.2026.102005},
url = {https://doi.org/10.1016/j.lanwpc.2026.102005},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Postpartum risk and prognosis of pregnancy-associated intracerebral haemorrhage: a nationwide cohort-crossover study
AU - Yu-Ning Chen
AU - Hao-Hsiang Hsu
AU - Michael Chun-Yuan Cheng
AU - Brian Meng-Hsun Li
AU - Yu Shyr
AU - Edward Chia-Cheng Lai
AU - Chao-Han Lai
PY - 2026
DA - 2026/10/01
JO - The Lancet Regional Health. Western Pacific
DO - 10.1016/j.lanwpc.2026.102005
UR - https://doi.org/10.1016/j.lanwpc.2026.102005
AB - 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 .
SN - 2666-6065
ER -