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Cerebral Aneurysms in Pregnancy and Delivery: Pregnancy and Delivery Do Not Increase the Risk of Aneurysm Rupture

Kim, Young Woo MD*; Neal, Dan MS; Hoh, Brian L. MD§

doi: 10.1227/NEU.0b013e3182796af9
Research-Human-Clinical Studies
Press Release

BACKGROUND: It is not known what effect pregnancy or delivery has on the risk of rupture of an intracranial aneurysm, and, consequently, the optimal management of unruptured aneurysms in pregnancy is unclear.

OBJECTIVE: To study the effect of pregnancy and delivery on the risk of rupture of intracranial aneurysms and to delineate trends in neurosurgical and obstetric management of pregnant women with intracranial aneurysms.

METHODS: The Nationwide Inpatient Sample data were analyzed for years 1988 to 2009 to estimate the risk of aneurysm rupture during pregnancies and deliveries. We calculated the risk by dividing the observed number of patients with ruptured aneurysm during pregnancy and delivery by the expected number based on the incidence among women of pregnancy age.

RESULTS: There were 714 and 172 hospitalizations involving ruptured aneurysms with pregnancy and delivery, respectively. Assuming 1.8% prevalence of unruptured aneurysms among all women of pregnancy age, we estimated that 48 873 women hospitalized for pregnancy and 312 128 women hospitalized for delivery had unruptured aneurysms. The risks of rupture during pregnancy and deliveries were 1.4% (95% confidence interval [CI] = [1.35, 1.57]) and 0.05% (95% CI = [0.0468, 0.0634]), respectively. Of 218 deliveries performed with unruptured aneurysm, 153 were cesarean deliveries (70.18%, 95% CI = [64.06, 76.30%]), suggesting that the rate of cesarean deliveries in patients with unruptured aneurysms is significantly higher than in the general population (P < .001).

CONCLUSION: We were not able to find an increased association between pregnancy or delivery and the risk of rupture of cerebral aneurysms. The significantly higher rate of cesarean deliveries performed in patients with unruptured aneurysms may not be necessary.

ABBREVIATIONS: CI, confidence interval

ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification

NIS, Nationwide Inpatient Sample

SAH, subarachnoid hemorrhage

*Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

Department of Biostatistics, University of Florida, Gainesville, Florida

§Department of Neurosurgery, University of Florida, Gainesville, Florida

Correspondence: Brian L. Hoh, MD, Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL 32610. E-mail:

Received May 17, 2012

Accepted October 02, 2012

Copyright © by the Congress of Neurological Surgeons