1. Risk of intracranial hemorrhage associated with pregnancy in women with cerebral arteriovenous malformations
- Author
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Youngran Kim, Spiros Blackburn, Louise D. McCullough, Farhaan S Vahidy, Victor Lopez-Rivera, Hooman Kamel, James C. Grotta, Rania Abdelkhaleq, Sergio Salazar-Marioni, Songmi Lee, Sunil A Sheth, Annika Medhus, Peng R Chen, Arvind B Bambhroliya, Sean I Savitz, and Babak B. Navi
- Subjects
Adult ,Intracranial Arteriovenous Malformations ,medicine.medical_specialty ,Pregnancy Complications, Cardiovascular ,Risk Assessment ,Preeclampsia ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Medicine ,Humans ,030212 general & internal medicine ,Healthcare Cost and Utilization Project ,Stroke ,Retrospective Studies ,Eclampsia ,business.industry ,Obstetrics ,Arteriovenous malformation ,General Medicine ,medicine.disease ,United States ,Gestational diabetes ,Relative risk ,Surgery ,Female ,Neurology (clinical) ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery - Abstract
BackgroundPrior studies on rupture risk of brain arteriovenous malformations (AVMs) in women undergoing pregnancy and delivery have reported conflicting findings, but also have not accounted for AVM morphology and heterogeneity. Here, we assess the association between pregnancy and the risk of intracranial hemorrhage (ICH) in women with AVMs using a cohort-crossover design in which each woman serves as her own control.MethodsWomen who underwent pregnancy and delivery were identified using DRG codes from the Healthcare Cost and Utilization Project State Inpatient Databases for California (2005–2011), Florida (2005–2014), and New York (2005–2014). The presence of AVM and ICH was determined using ICD 9 codes. Pregnancy was defined as the 40 weeks prior to delivery, and postpartum as 12 weeks after. We defined a non-exposure control period as a 52-week period prior to pregnancy. The relative risks of ICH during pregnancy were compared against the non-exposure period using conditional Poisson regression.ResultsAmong 4 022 811 women identified with an eligible delivery hospitalization (median age, 28 years; 7.3% with gestational diabetes; 4.5% with preeclampsia/eclampsia), 568 (0.014%) had an AVM. The rates of ICH during pregnancy and puerperium were 6355.4 (95% CI 4279.4 to 8431.5) and 14.4 (95% CI 13.3 to 15.6) per 100 000 person-years for women with and without AVM, respectively. In cohort-crossover analysis, in women with AVMs the risk of ICH increased 3.27-fold (RR, 95% CI 1.67 to 6.43) during pregnancy and puerperium compared with a non-pregnant period.ConclusionsAmong women with AVM, pregnancy and puerperium were associated with a greater than 3-fold risk of ICH.
- Published
- 2020