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Haemorrhage risk of brain arteriovenous malformation during pregnancy and puerperium
  1. Junyu Liu1,2,
  2. Honghao Zhang1,
  3. Chun Luo3,
  4. Yuxin Guo3,
  5. Yifeng Li1,
  6. Dun Yuan1,
  7. Weixi Jiang1,
  8. Junxia Yan3,4
  1. 1 Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan, China
  2. 2 Department of Pharmacology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
  3. 3 Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
  4. 4 Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University Xiangya School of Public Health, Changsha, Hunan, China
  1. Correspondence to Dr Junxia Yan; 20457456{at}qq.com; Dr Yifeng Li; liyifeng87{at}csu.edu.cn

Abstract

Background This study aimed to assess whether pregnancy and puerperium were associated with the risk of brain arteriovenous malformation (bAVM) haemorrhage.

Methods A retrospective review was conducted in Xiangya Hospital, Central South University from January 2012 to December 2021. A case–crossover design was adopted to calculate the incidence density of bAVM-related haemorrhage among female patients in risk (pregnancy and puerperium) and control (non-pregnancy and non-puerperium) periods, according to four scenarios observed in different populations (scenario I: patients with haemorrhagic bAVM of all ages; scenario II: patients with haemorrhagic bAVM of all ages, with at least one previous pregnancy; scenario III: patients with haemorrhagic bAVM who are of reproductive age (15–45 years); scenario IV: patients with haemorrhagic bAVM of reproductive age (15–45 years), with at least one previous pregnancy. Next, a comprehensive literature aggregation (up to April 2022) was performed for evidence synthesis.

Results Among the 311 female patients with haemorrhagic bAVM, a significant haemorrhage risk during pregnancy and puerperium was found in Scenarios I (relative risk [RR], 2.08; 95% CI, 1.28 to 3.39), II (RR, 3.21; 95% CI, 1.95 to 5.31) and IV (RR, 2.92; 95% CI, 1.73 to 4.93); however, a suggestive risk was found in scenario III (RR, 1.62; 95% CI, 0.99 to 2.67). Evidence synthesis revealed a consistent haemorrhage risk among patients of all ages (RR, 3.15; 95% CI, 1.93 to 5.15) and those of reproductive age (RR, 1.29; 95% CI, 0.89 to 1.86).

Conclusion Compared with most previous studies, a higher but relatively moderate risk for bAVM-related haemorrhage was identified during pregnancy and puerperium. Individualised prevention and treatment strategies should be preferred when neurosurgeons make clinical decisions.

  • Stroke
  • Arteriovenous Malformations
  • Haemorrhage
  • Pregnancy

Data availability statement

Data are available in a public, open access repository.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2022-001921

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    Data availability statement

    Data are available in a public, open access repository.

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    Footnotes

    • Contributors JL: data curation, statistical analysis, investigation, validation, resources and software, writing for original draft, writing for review and editing. HZ: data curation, investigation. CL: statistical analysis. YG: statistical analysis. YL: data curation, investigation, validation, funding acquisition. DY: funding acquisition. WJ: funding acquisition. JY: guarantor, project administration and supervision, methodology, funding acquisition, statistical analysis, writing for original draft, writing for review and editing.

    • Funding This study was supported by the grants from the Hunan Province Nature Science Foundation, China (2021JJ30911, 2021JJ31077, 2021JJ31121), Financial Science and Technology Project of Hunan Province, China (422000008), Central South University Case Database Construction Project for Graduate Students, China (2020ALK24).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.