Objective:

To determine whether patients presenting for delivery with preeclampsia or eclampsia experience worse maternal outcomes if complicated by Posterior Reversible Encephalopathy Syndrome (PRES). 

Background:

Hypertensive disorders of pregnancy are a major cause of maternal morbidity and mortality. Preeclampsia and eclampsia are well known hypertensive disorders and there have been few single-center studies suggesting preeclampsia or eclampsia with comorbid PRES have worse maternal outcomes, but no national-level data has been evaluated.  

Design/Methods:

Using the 2016 to 2022 Nationwide Readmissions Database, we identified adult hospitalizations for delivery with preeclampsia or eclampsia and stratified by PRES. Primary outcomes included in-hospital death, mechanical ventilation, status epilepticus, seizures, acute kidney failure, hepatic failure, stroke, pulmonary embolism, venous thromboembolism, and length of stay, as well as 30- and 90-day readmissions. Logistic regression models were estimated for categorical outcomes, whereas lognormal models were estimated for length of stay. When appropriate, multivariable models adjusted for age, preeclampsia, history of epilepsy, and history of stroke. 

Results:

From 2016-2022, there were an estimated 1,699,591 hospitalizations meeting inclusion criteria, of which 0.1% included PRES. PRES was associated with patients who were younger, higher rates of Medicaid beneficiaries and history of epilepsy, and lower rates of preeclampsia and gestational diabetes (all p < .001). PRES was associated with longer lengths of stay (adjusted ratio [AR]: 1.59, 95% CI: 1.49-1.70), higher rates of seizure (AR: 13.37, 95% CI: 10.07-17.75) and acute kidney failure (AR: 10.96, 95% CI: 8.60-13.98). No adjusted differences were observed for readmissions. 

Conclusions:

This study aimed to provide national-level evidence evaluating the association of PRES with maternal outcomes in preeclampsia and eclampsia. Findings identified outcomes that could inform monitoring, management, and delivery planning to mitigate morbidity and mortality in mothers.