Risk of first hemorrhage of brain arteriovenous malformations during pregnancy: a systematic review of the literature

Christopher L. Davidoff, Anna Lo Presti, Jeffrey M. Rogers, Mary Simons, Nazih N.A. Assaad, Marcus Andrew Stoodley, Michael Kerin Morgan

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Background: Recommendations on the management of brain arteriovenous malformations (bAVM) with respect to pregnancy are based upon conflicting literature. Objective: To systematically review the reported risk and annualized rate of first intracranial hemorrhage (ICH) from bAVM during pregnancy and puerperium. Methods: MEDLINE, EMBASE, and Scopus databases were searched for relevant articles in English published before April 2018. Studies providing a quantitative risk of ICH in bAVM during pregnancy were eligible. Results: From 7 initially eligible studies, 3 studies met the criteria for providing quantitative risk of first ICH bAVM during pregnancy. Data from 47 bAVM ICH during pregnancy across 4 cohorts were extracted for analysis. Due to differences in methodology and definitions of exposure period, it was not appropriate to combine the cases. The annualized risk of first ICH during pregnancy for these 4 cohorts was 3.0% (95% confidence interval [CI]: 1.7-5.2%); 3.5% (95% CI: 2.4-4.5%); 8.6% (95% CI: 1.8-25%); and 30% (95% CI: 18-49%). Only the last result from the last cohort could be considered significantly increased in comparison with the nonpregnant period (relative rate 6.8, 95% CI: 3.6-13). The limited number of eligible studies and variability in results highlighted the need for enhanced rigor of future research. Conclusion: There is no conclusive evidence of an increased risk of first hemorrhage during pregnancy from bAVM. Because advice to women with bAVM may influence the management of pregnancy or bAVM with significant consequences, we believe that a retrospective multicenter, case crossover study is urgently required.

LanguageEnglish
PagesE806-E813
Number of pages9
JournalClinical Neurosurgery
Volume85
Issue number5
DOIs
Publication statusPublished - 1 Nov 2019

Fingerprint

Intracranial Hemorrhages
Arteriovenous Malformations
Pregnancy
Brain
Confidence Intervals
Intracranial Arteriovenous Malformations
MEDLINE
Cross-Over Studies
Postpartum Period
Databases
Hemorrhage

Keywords

  • Arteriovenous malformation
  • AVM
  • Brain
  • Pregnancy
  • Systematic review
  • Treatment

Cite this

Davidoff, Christopher L. ; Lo Presti, Anna ; Rogers, Jeffrey M. ; Simons, Mary ; Assaad, Nazih N.A. ; Stoodley, Marcus Andrew ; Morgan, Michael Kerin. / Risk of first hemorrhage of brain arteriovenous malformations during pregnancy : a systematic review of the literature. In: Clinical Neurosurgery. 2019 ; Vol. 85, No. 5. pp. E806-E813.
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abstract = "Background: Recommendations on the management of brain arteriovenous malformations (bAVM) with respect to pregnancy are based upon conflicting literature. Objective: To systematically review the reported risk and annualized rate of first intracranial hemorrhage (ICH) from bAVM during pregnancy and puerperium. Methods: MEDLINE, EMBASE, and Scopus databases were searched for relevant articles in English published before April 2018. Studies providing a quantitative risk of ICH in bAVM during pregnancy were eligible. Results: From 7 initially eligible studies, 3 studies met the criteria for providing quantitative risk of first ICH bAVM during pregnancy. Data from 47 bAVM ICH during pregnancy across 4 cohorts were extracted for analysis. Due to differences in methodology and definitions of exposure period, it was not appropriate to combine the cases. The annualized risk of first ICH during pregnancy for these 4 cohorts was 3.0{\%} (95{\%} confidence interval [CI]: 1.7-5.2{\%}); 3.5{\%} (95{\%} CI: 2.4-4.5{\%}); 8.6{\%} (95{\%} CI: 1.8-25{\%}); and 30{\%} (95{\%} CI: 18-49{\%}). Only the last result from the last cohort could be considered significantly increased in comparison with the nonpregnant period (relative rate 6.8, 95{\%} CI: 3.6-13). The limited number of eligible studies and variability in results highlighted the need for enhanced rigor of future research. Conclusion: There is no conclusive evidence of an increased risk of first hemorrhage during pregnancy from bAVM. Because advice to women with bAVM may influence the management of pregnancy or bAVM with significant consequences, we believe that a retrospective multicenter, case crossover study is urgently required.",
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Risk of first hemorrhage of brain arteriovenous malformations during pregnancy : a systematic review of the literature. / Davidoff, Christopher L.; Lo Presti, Anna; Rogers, Jeffrey M.; Simons, Mary; Assaad, Nazih N.A.; Stoodley, Marcus Andrew; Morgan, Michael Kerin.

In: Clinical Neurosurgery, Vol. 85, No. 5, 01.11.2019, p. E806-E813.

Research output: Contribution to journalReview articleResearchpeer-review

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AU - Davidoff, Christopher L.

AU - Lo Presti, Anna

AU - Rogers, Jeffrey M.

AU - Simons, Mary

AU - Assaad, Nazih N.A.

AU - Stoodley, Marcus Andrew

AU - Morgan, Michael Kerin

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KW - Systematic review

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