Abstract WP140: Odds of Pregnancy-related Reversible Cerebral Vasoconstriction Syndrome with Pre-Eclampsia or Eclampsia: A Case-Control Study

Introduction: Pregnancy-related reversible cerebral vasoconstriction syndrome (RCVS) is associated with high rates of intracerebral complications and is an important cause of maternal morbidity and mortality. Case reports suggest pre-eclampsia and eclampsia (PEC) as possible mediators of RCVS; however, data are limited to confirm and quantify this association. We estimated the odds of RCVS in pregnancy and postpartum state associated with PEC, and determined the proportion of pregnancy-related RCVS attributable to PEC. Hypotheses: 1) Among pregnant and postpartum (<12 weeks) women, PEC increases the odds of RCVS, and 2) the majority of RCVS in this population is attributable to PEC. Methods: We performed a single-center, retrospective, case-control study (2010-2024). Cases were identified from hospital billing data and confirmed as RCVS based on the combination of typical clinical presentation, ≥1 imaging modality consistent with vasoconstriction, and absence of an alternative diagnosis. Controls were pregnant or postpartum patients selected from hospital quality database in a 3:1 ratio to cases and matched for delivery month and year. The primary exposure was PEC diagnosis preceding or concurrent with RCVS. We used binary logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) of RCVS associated with PEC, adjusting for confounders. We calculated the fraction of RCVS attributable to PEC using unadjusted odds ratio (rare disease assumption). Results: We identified 40 RCVS cases and 120 controls. Age, delivery mode, and risk factors, including chronic hypertension did not differ between groups (Image 1). Cases had a higher proportion of preterm birth (21% vs. 8%, P <0.001) and shorter pregnancy length (median 37 (36-38) vs. 39 (37-39) weeks) compared to controls. PEC was noted in 72% of cases and 10% of controls ( P <0.001). Most RCVS (80%), and PEC (62%) among the cases, occurred postpartum. Among the cases, 55% had associated intracranial complications (hemorrhage, infarction, or posterior reversible encephalopathy syndrome); 45% required intensive care; and 15% were discharged to rehabilitation (Image 2). Adjusting for gravidity, pregnancy length, and postpartum status at PEC diagnosis, PEC increased the odds of RCVS (aOR 28, 95% CI 10-83). The fraction of RCVS attributable to PEC was 95%. Conclusion: PEC is associated with greatly increased odds of pregnancy-associated RCVS, and is likely to be the major risk factor for this condition.