Risk of cerebral arteriovenous malformation rupture during pregnancy and puerperium.
OBJECTIVE
To determine whether the risk of arteriovenous malformation (AVM) rupture is increased during pregnancy and puerperium.


METHODS
Participants included 979 female patients with intracranial AVM admitted to Beijing Tiantan Hospital between 1960 and 2010. Two neurosurgery residents reviewed medical records for each case. Of them, 393 patients with ruptured AVM between 18 and 40 years of age were used for case-crossover analysis. Number of children born and clinical information during pregnancy and puerperium were retrieved to identify whether AVM rupture occurred during this period.


RESULTS
Of the 979 women, 797 hemorrhages occurred during 25,578 patient-years of follow-up, yielding an annual hemorrhage rate of 3.11%. The annual AVM hemorrhage rate in patients aged 18 to 40 years (n = 579) was 2.78%, lower than the rate in other age groups (odds ratio = 0.75, 95% confidence interval 0.65-0.86, p < 0.05). Of the 393 patients with rupture of AVM aged 18 to 40 years, 12 hemorrhages occurred in 12 patients over 452 pregnancies, yielding a hemorrhage rate of 2.65% per pregnancy or 3.32% per year. Among the remaining 381 patients, 441 hemorrhages occurred during 10,627 patient-years of follow-up, yielding an annual hemorrhage rate of 4.14%. The odds ratio for rupture of AVM during pregnancy and puerperium, compared with the control period, was 0.71 (95% confidence interval 0.61-0.82).


CONCLUSIONS
No increased risk of hemorrhage was found in patients with cerebral AVM during pregnancy and the puerperium. We therefore would not advise against pregnancy in women with intracranial AVM.
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK. Zhaojz205@gmail.com liuxingju006@sina.com.
Xing-ju
XJ
Liu
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Shuo
S
Wang
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Yuan-li
YL
Zhao
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Mario
M
Teo
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Peng
P
Guo
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Dong
D
Zhang
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Rong
R
Wang
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Yong
Y
Cao
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Xun
X
Ye
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK.
Shuai
S
Kang
From the Department of Neurosurgery, Beijing Tiantan Hospital (X.-j.-L., S.W., Y.-l.Z., M.T., D.Z., R.W., Y.C., X.Y., S.K., J.-Z.Z.), and Department of Neurosurgery, Beijing Chao-Yang Hospital (P.G.), Capital Medical University, Beijing, China; and Department of Neurosurgery (M.T.), Institute of Neurological Science, Glasgow, UK. Zhaojz205@gmail.com liuxingju006@sina.com.
Ji-Zong
JZ
Zhao
D000328:Adult; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D012306:Risk