Aneurysmal and arteriovenous malformation hemorrhage during pregnancy: An update on the epidemiology, risk factors and prognosis

Clin Neurol Neurosurg. 2021 Sep:208:106897. doi: 10.1016/j.clineuro.2021.106897. Epub 2021 Aug 20.


Introduction: Intracranial hemorrhage (ICH) is a devastating condition with a high rate of morbidity and mortality. Aneurysm or arteriovenous malformation (AVM) rupture are two common etiologies leading to ICH. Here we provide an update on ICH during pregnancy with a focus on those caused by aneurysm or AVM rupture.

Methods: Here we systematically review 25 studies reported in the literature to provide an update on ICH during pregnancy focusing on aneurysm or AVM rupture. We also reviewed the prognosis of ICH during puerperium.

Results: Discrepancies exist between studies supporting or refuting the hypothesis of a higher rate of ICH during pregnancy, obscuring the overall rate of aneurysm and AVM rupture in pregnant ICH patients. However, risk factors such as maternal age and hypertension have shown to increase the frequency of ICH in pregnant patients. We also show increased morbidity and mortality in patients suffering from preeclampsia/eclampsia.

Discussion: ICH is rare, but the various studies demonstrating its increased frequency, morbidity, and mortality during pregnancy should raise our awareness of this condition. The management and treatment decisions for a pregnant ICH patient should follow the same principles as nonpregnant patients, but with the knowledge that not all medications are appropriate for use in the pregnant patient. Although there seems to be a higher frequency of AVM rupture, further research must be conducted in order to fully determine the effects of pregnancy on aneurysm and AVM ruptures.

Keywords: Aneurysm; Arteriovenous malformation; Intracranial hemorrhage; Pregnancy.

MeSH terms

  • Aneurysm, Ruptured / epidemiology*
  • Female
  • Hemorrhagic Stroke / epidemiology*
  • Humans
  • Incidence
  • Intracranial Arteriovenous Malformations / epidemiology*
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / epidemiology*
  • Prognosis
  • Risk Factors