To describe usage of IV alteplase (tPA) and endovascular treatment (ET) in pregnant patients with acute ischemic stroke (AIS); to determine trends in hospital length of stay (LOS), discharge disposition (DD) and in-hospital mortality over time for pregnant women with AIS.

Limited clinical guidelines of stroke in pregnancy exist due to lack of clinical trial data. Knowledge of outcomes of tPA and ET among stroke in pregnant women is minimal.

Data was abstracted from the Nationwide Inpatient Sample (NIS), an all-payer inpatient database, from 2005-2015 third quarter (Q3). ICD-9 diagnostic and procedure codes identified pregnancy-related hospitalizations, AIS, and those receiving tPA and/or ET. Clinical outcomes included LOS, DD and in-hospital mortality. 

We identified 30,818 pregnant women with stroke; 6,515 (21.1%) were diagnosed with AIS. Overall, 3.7% (N=243) received tPA. There was a statistically significant increasing trend in use of tPA from 2005 to 2015(Q3) (N=5, 0.9% in 2005; N=35, 6.3% in 2015; p=0.003). Overall, ET was rare (0.53%, N=34 during study period). The most common DD was home without home services (56.3%) and mean LOS was 6.7 days (SE=0.7); 4 patients died in the hospital (1.9%). Regression analysis of LOS, DD and in-hospital mortality for pregnant AIS patients who received tPA revealed significant decreasing trends in LOS (p=0.02) and in-hospital mortality (p=0.005) over time from 2005 to 2015(Q3).

From 2005 to 2015, pregnant AIS patients received tPA with greater frequency, got discharged from the hospital sooner, and suffered fewer in-hospital deaths. The use of ET in pregnant AIS patients was very rare. Given the future expansion of tPA and ET usage for AIS in time and indication, further research is necessary to understand the factors influencing stroke outcomes in this vulnerable population and to ensure this encouraging trend in clinical outcomes continues.