Gestational aortic dissection: Clinical features and morphological predictors—a case-control study

Objective To investigate the clinical characteristics and aortic morphological features of gestational aortic dissection (GAD), and to identify potential clinical and imaging risk factors. Materials and Methods Clinical data and aortic computed tomography angiography (CTA) images from 43 women with GAD were retrospectively analyzed and compared with two control cohorts: 100 women undergoing cesarean delivery without dissection (clinical controls) and 22 age-matched women with normal aortic CTA findings (imaging controls). Aortic diameters, arch length, arch angulation, and curvature-related indices were measured independently by two experienced cardiovascular radiologists. Results Chest/back pain was the predominant presentation (81.4%). Chronic hypertension (27.9%), Marfan syndrome (20.9%), and hypoproteinemia (32.6%) were common associated conditions; 70% of women with aortopathy were not diagnosed before dissection, and 20.9% had no known risk factors. Type A dissection (62.8%) occurred mainly in the third trimester, whereas type B dissection (37.2%) showed more heterogeneous timing, including postpartum events. Compared with cesarean controls, women with GAD were taller (171.1 vs. 161.9 cm, P < 0.001), had higher systolic blood pressure (131.1 vs. 120.5 mmHg, P = 0.010) and pulse pressure (60.6 vs. 45.7 mmHg, P < 0.001), and had higher gravidity (2.33 vs. 1.86, P = 0.012) and parity (0.86 vs. 0.26, P < 0.001). Compared with imaging controls, women with GAD had significantly larger diameters across all aortic segments and a significantly shorter aortic arch length ( P < 0.001), while arch angles and curvature-related parameters were not significantly different. Conclusion GAD is associated with a distinct clinical-morphological profile beyond traditional risk factors. In addition to established contributors such as hypertension and connective tissue disease, increased maternal height, higher gravidity/parity, and shorter aortic arch length may contribute to risk stratification. The high prevalence of unrecognized aortopathy and dissection in previously healthy women supports a low threshold for evaluation in symptomatic pregnancy.