title: Cerebral aneurysms in pregnancy and delivery:  pregnancy and delivery do not increase the risk of aneurysm rupture.
abstract: BACKGROUND
  It is not known what effect pregnancy or delivery has on the risk of rupture of an intracranial aneurysm, and, consequently, the optimal management of unruptured aneurysms in pregnancy is unclear.
  
  
  OBJECTIVE
  To study the effect of pregnancy and delivery on the risk of rupture of intracranial aneurysms and to delineate trends in neurosurgical and obstetric management of pregnant women with intracranial aneurysms.
  
  
  METHODS
  The Nationwide Inpatient Sample data were analyzed for years 1988 to 2009 to estimate the risk of aneurysm rupture during pregnancies and deliveries. We calculated the risk by dividing the observed number of patients with ruptured aneurysm during pregnancy and delivery by the expected number based on the incidence among women of pregnancy age.
  
  
  RESULTS
  There were 714 and 172 hospitalizations involving ruptured aneurysms with pregnancy and delivery, respectively. Assuming 1.8% prevalence of unruptured aneurysms among all women of pregnancy age, we estimated that 48,873 women hospitalized for pregnancy and 312,128 women hospitalized for delivery had unruptured aneurysms. The risks of rupture during pregnancy and deliveries were 1.4% (95% confidence interval [CI] = [1.35, 1.57]) and 0.05% (95% CI = [0.0468, 0.0634]), respectively. Of 218 deliveries performed with unruptured aneurysm, 153 were cesarean deliveries (70.18%, 95% CI = [64.06, 76.30%]), suggesting that the rate of cesarean deliveries in patients with unruptured aneurysms is significantly higher than in the general population (P < .001).
  
  
  CONCLUSIONS
  We were not able to find an increased association between pregnancy or delivery and the risk of rupture of cerebral aneurysms. The significantly higher rate of cesarean deliveries performed in patients with unruptured aneurysms may not be necessary.
authors.affiliation: Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Young Woo
authors.initials: YW
authors.lastname: Kim
authors.forename: Dan
authors.initials: D
authors.lastname: Neal
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hoh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017542:Aneurysm, Ruptured / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult