Pregnancy and Clinical Risks of Spinal Cord Arteriovenous Shunts: A Nationwide Multicenter Retrospective Cohort Study

Intermittent reports of spinal cord arteriovenous shunts (SCAVSs)-induced paralysis during pregnancy and puerperium have raised significant concerns. This study aimed to assess whether women with SCAVSs are at an elevated clinical risk during this period.

Consecutive female patients with SCAVSs from 10 referral centers were included. Only clinical data within reproductive age were analyzed. The primary outcome was the occurrence of clinical deterioration associated with SCAVSs, categorized into acute and gradual patterns based on the modified Aminoff and Logue scale.

A total of 480 patients were included. Before initial treatment, 262 patients experienced pregnancy. Both acute (17.88%/y vs 4.87%/y, P < .0001) and gradual (9.67%/y vs 3.27%/y, P < .0001) deterioration during pregnancy and puerperium were significantly elevated. In the matched cohort of 72 pregnant patients with untreated SCAVSs and their nonpregnant control, acute deterioration was significantly higher in the pregnant patients (26.09%/y vs 6.97%/y, P = .013). After partial SCAVSs obliteration, acute (33.74%/y vs 5.15%/y, P < .0001) and gradual (18.40%/y vs 2.61%/y, P = .0008) deterioration rates during this period were still significantly elevated. In the matched cohort of 23 pregnant patients with residual SCAVSs and their nonpregnant control, acute deterioration was still significantly higher in the pregnant patients (39.50%/y vs 6.25%/y, P = .043). In addition, no significant decrease in the clinical deterioration was observed after partial treatment compared with nontreated patients during this period.

The risk of clinical deterioration associated with SCAVSs is significantly elevated during pregnancy and puerperium.