Pregnancy Outcomes and Anesthetic Practices in a Cohort of Moyamoya Disease Patients

Introduction: MoyaMoya disease (MMD) is a steno-occlusive disease affecting large intracranial arteries that often affects women during child-bearing years. To compensate for the restriction in blood flow, delicate collaterals form with the potential to hemorrhage. The risk of both ischemic and hemorrhagic stroke complicates pregnancy and delivery for MMD patients.

Methods: We identified 15 patients with MMD, totaling 18 deliveries at our tertiary care center from 2011-2024. Data collected included surgical bypass treatments, stroke history, neurology/neurosurgery consults in pregnancy, mode of delivery, type of anesthesia, and intrapartum stroke or seizure occurrence.

Results: Age at diagnosis ranged from 7-40 years old and the age at delivery ranged from 22-36 years old. All patients were diagnosed before their pregnancy except for one. Nine of the women underwent bypass surgery before their pregnancy (60%) and 10 had a stroke before their pregnancy (66.6%). Eleven patients (64.7%) were seen by neurosurgery or neurology in the antepartum period. Of these, five were cleared for vaginal delivery (45.5%), three were cleared for neuraxial anesthesia (27.3%), and none were explicitly denied clearance. Eleven patients underwent caesarean section (61.1%), three of which were emergencies (16.7%). Seven of the pregnancies resulted in successful vaginal delivery (41.2%) and nine received neuraxial anesthesia (50%). Labor was induced in two patients (11.76%) due to worsening hypertension with superimposed pre-eclampsia. The average gestational age at delivery was 35.6 weeks (24-39 weeks). Eight deliveries occurred prematurely (before 37 weeks, 44.4%). There were no maternal deaths, intrapartum strokes, seizures, or stillbirths.

Conclusion : This study provides evidence that MDD is not a contraindication for vaginal delivery or neuraxial anesthesia. These patients did not experience stroke during delivery regardless of the anesthesia method used, though many gave birth prematurely. The effects of MDD on pregnancy complications and best delivery practices should be explored in future research.