Relative risk of hemorrhage during pregnancy in patients with brain arteriovenous malformations

Janneke van Beijnum*, Tim Wilkinson, Heather J. Whitaker, Johanna G. van der Bom, Ale Algra, W. Peter Vandertop, René van den Berg, Patrick A. Brouwer, Gabriël J.E. Rinkel, L. Jaap Kappelle, Rustam Al-Shahi Salman, Catharina J.M. Klijn, for the Scottish Audit of Intracranial Vascular Malformations collaborators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: It is unclear whether the risk of bleeding from brain arteriovenous malformations is higher during pregnancy, delivery, or puerperium. We compared occurrence of brain arteriovenous malformation hemorrhage in women during this period with occurrence of hemorrhage outside this period during their fertile years. Methods: We included all women with ruptured brain arteriovenous malformations (16–41 years) from a retrospective database of patients with brain arteriovenous malformations in four Dutch university hospitals (n = 95) and from the population-based Scottish Audit of Intracranial Vascular Malformations (n = 44). We estimated the relative rate of brain arteriovenous malformation rupture (before any treatment) during exposed time (pregnancy, delivery, puerperium) versus non-exposed time during fertile years, using the case-crossover design as primary analysis, and the self-controlled case-series design as secondary analysis. Results: In 17 of 95 Dutch women and in 3 of 44 Scottish women, hemorrhages occurred while pregnant; none occurred during delivery or puerperium. In Dutch women, the relative rate of brain arteriovenous malformation rupture during pregnancy, delivery, or puerperium was 6.8 (95% confidence interval 3.6–13) according to the case-crossover method and 7.1 (95% confidence interval 3.4–13) using the self-controlled case-series method. In Scottish women, the relative rate was 1.3 (95% confidence interval 0.39–4.1) using the case-crossover method and 1.7 (95% confidence interval 0.0–4.4) according to the self-controlled case-series method. Because of limited overlap of confidence intervals, we refrained from pooling the cohorts. Conclusions: Case-crossover and self-controlled case series analyses reveal an increase in relative rate of brain arteriovenous malformation rupture during pregnancy in the Dutch cohort but not in the Scottish cohort. Since point estimates varied between both cohorts and numbers are relatively small, the clinical implications of our findings are uncertain.

Original languageEnglish
Pages (from-to)741-747
Number of pages7
JournalInternational Journal of Stroke
Volume12
Issue number7
DOIs
Publication statusPublished - 1 Oct 2017

Cite this

van Beijnum, J., Wilkinson, T., Whitaker, H. J., van der Bom, J. G., Algra, A., Vandertop, W. P., ... for the Scottish Audit of Intracranial Vascular Malformations collaborators (2017). Relative risk of hemorrhage during pregnancy in patients with brain arteriovenous malformations. International Journal of Stroke, 12(7), 741-747. https://doi.org/10.1177/1747493017694387