Introduction: Intracranial aneurysm rupture is the primary cause of non-traumatic subarachnoid hemorrhage (SAH). Although numerous risk factors have been identified, there is limited literature addressing pregnancy as one of them. This study focuses on evaluating the role of pregnancy as a predictor of aneurysmal rupture in female patients with intracranial aneurysm.
Methods: The National Inpatient Sample (NIS) from HCUP was queried from 2003 to 2020 to identify pregnant patients with intracranial aneurysms (IAs) using ICD-9 code 437.5 and ICD-10 code I67.5. A standardized method adjusted for ICD code transitions. Patients were divided into pregnant and non-pregnant cohorts, matched using the K-Nearest Neighbor (KNN) algorithm.
Results: Of the 113,311 patients identified, 112,136 were non-pregnant and 1,175 were pregnant. Following KNN matching, each group had 1,175 patients. Both groups had similar mean age (46.649 ± 18.628 years for non-pregnant vs 46.711 ± 18.534 years for pregnant), racial distributions and geographical locations. Non-pregnant women (13.7% vs 4.7%) were more likely to be treated surgically, whereas endoscopic was the preferred intervention among pregnant women (8.7% vs 1.0%), these differences were statistically significant (p < 0.001). Pregnant women had nearly nine times the odds of aneurysmal rupture compared to non-pregnant women. Mortality was significantly higher in non-pregnant compared to pregnant (1.9% vs 0.6%, p=0.005). Multivariate logistic regression predicting aneurysmal rupture showed that pregnant patients had higher odds (OR: 8.62, p< 0.001) of aneurysm rupture. Furthermore, endovascular treatment had lower odds (OR: 0.4, p< 0.01) of aneurysm rupture same as diabetes (OR: 0.8, p< 0.01 ). Congestive heart failure, and history of atrial fibrillation conferred higher odds of aneurysm rupture. The SHAP features importance plot using the Random Forest algorithm (AUC=0.87) showed that pregnancy, followed by the type of treatment and history of dyslipidemia, are the top factors associated with aneurysmal rupture in our cohort.
Conclusion : This study highlights pregnancy as a key predictor of aneurysmal rupture. Paradoxically, pregnant women had better survival chances in comparison to non-pregnant.
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