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Updated: May 23, 2026
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Hemorrhage from arteriovenous malformations during pregnancy
1Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Neurosurgery
|April 5, 2012
Summary
Pregnancy significantly increases the risk of arteriovenous malformation (AVM) hemorrhage. Women with AVMs considering childbearing should discuss intervention options due to this elevated risk.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Obstetrics & Gynecology
Background:
- Established risk factors for arteriovenous malformation (AVM) hemorrhage include prior bleeding, deep venous drainage, and deep lesion location.
- Pregnancy is widely assumed to be a risk factor for AVM hemorrhage, but supporting data are limited.
Purpose of the Study:
- To determine the hemorrhage rate of AVMs in women during pregnancy.
Main Methods:
- A retrospective review of 54 women diagnosed with AVMs was conducted.
- Annual hemorrhage rates were calculated, and a Cox proportional hazards model was used to assess the impact of pregnancy as a time-dependent variable.
Main Results:
- A hemorrhage rate of 8.1% per pregnancy (10.8% annually) was observed during 62 pregnancies.
- The overall annual hemorrhage rate was 1.1% across 2461.3 patient-years.
- Pregnancy demonstrated a hazard ratio of 7.91 for hemorrhage, increasing to 18.12 when limited to follow-up until age 40.
Conclusions:
- Pregnancy poses a significantly elevated risk for AVM hemorrhage.
- Intervention is recommended for women with AVMs who wish to conceive, especially if the AVM has a history of bleeding.
- For AVMs discovered during pregnancy, early intervention is advised if ruptured; if unruptured, counseling is recommended to weigh intervention risks against pregnancy continuation.
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