Introduction: Females are at higher risk for intracranial aneurysms (IA), and although subarachnoid hemorrhage (SAH) during pregnancy is rare, it poses significant morbidity and mortality risks for both the mother and baby. However, the effect of pregnancy on aneurysm rupture remains unclear. This study aims to determine the risk of IA rupture during pregnancy and assess treatment outcomes in pregnant versus non-pregnant women.
Methods: We queried the National Inpatient Sample for female patients diagnosed with IAs from 2003 to 2020, categorizing them into pregnant and non-pregnant cohorts. We evaluated treatment rates and the incidence of SAH. Patients were matched 1:1 by race and age using KNN matching. Multivariable logistic regression and random forest classifiers identified preoperative characteristics, postoperative outcomes, and predictors of aneurysm rupture.
Results: Among 11,311 female patients with unruptured IAs, 1,175 were pregnant. Ruptured aneurysms occurred in 5.5% of pregnant versus 7% of non-pregnant patients. Treatment rates were 13.4% for pregnant and 15.9% for non-pregnant patients. After matching, pregnant patients had significantly fewer postoperative complications, including hemorrhagic stroke, neurological complications, and mortality. Multivariable logistic regression revealed that pregnancy was associated with 8.2 times higher odds of IA rupture (p < 0.001). Random forest analysis (AUC=0.87) identified pregnancy as the top predictor of rupture, corroborated by a second model with minimal depth and higher accuracy (AUC=0.95).
Conclusion : Pregnancy significantly increases the risk of intracranial aneurysm rupture, with pregnant women having 8.2 times higher odds of rupture compared to non-pregnant women. Despite the elevated risk, pregnant patients experience fewer postoperative complications. These findings underscore the need for individualized management strategies for IAs in pregnant woman to mitigate rupture risk and enhance maternal and fetal outcomes. Further research is essential to optimize treatment protocols and improve care for this vulnerable population.
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