To determine the incidence of stroke (intracerebral hemorrhage, ischemic stroke, and subarachnoid hemorrhage) in pregnant patients during antepartum, intrapartum, and postpartum periods with cavernous malformations (CM).
Cavernous malformations are vascular structures consisting of dilated vessels and are often asymptomatic. However, during pregnancy, changes in endocrine and hemodynamic factors may potentially cause CMs to change morphologically or bleed. Additionally, Valsalva maneuvers during vaginal delivery may increase intracranial pressure. To avoid possible complications during delivery, about 80% of pregnant patients with CM undergo a cesarean section. However, there is no evidence to suggest that vaginal deliveries increase the risk of hemorrhage in pregnant patients with CM.
We retrospectively compared the incidence of stroke using a Chi-squared test in individual deliveries of pregnant patients with CM compared to matched non-pregnant controls with CM during the same 9-month period in a Southern California Health System from January 1st, 2006, to September 30th, 2023.
Stroke incidence was higher among the 658 control patients (4.9%) compared to the 332 postpartum deliveries (0.9%) (p = .001). Non-pregnant patients were older (M = 42.39, SD = 9.44) than pregnant patients (M = 33.60, SD = 7.13, p < .001). There were more White patients in the non-pregnant group (31.2%) compared to the pregnant group (25.0%), although this difference only approached significance (p = .079). There was a higher percentage of Hispanic patients in the pregnant group (47.8%) than the non-pregnant group (38.4%) (p = .013). There was no association of stroke incidence with race/ethnicity and age. No strokes occurred during pregnancy or delivery.
Pregnancy was not associated with an increased risk of stroke in patients with CMs. These findings suggest that pregnancy and vaginal delivery are likely safe for patients with CM and that caesarean sections are less likely to be indicated.