Maternal and fetal outcomes of spinal cord stimulation in pregnancy: systematic review with descriptive meta-analysis

Spinal cord stimulation (SCS) is an established therapy for refractory neuropathic pain and is increasingly used in women of reproductive age. However, evidence regarding the safety of SCS during pregnancy remains limited, and consolidated outcome data are lacking. Our objective was to systematically evaluate maternal, device-related, obstetric, anesthetic, and neonatal outcomes in pregnancies among patients with implanted SCS.

A systematic review with descriptive pooled analysis was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Scopus, Web of Science, Cochrane, and Embase were searched. Patient-level characteristics were summarized per individual, whereas obstetric and neonatal outcomes were analyzed. Proportions were pooled using exact binomial confidence intervals, and continuous variables were summarized as weighted means ± standard deviations.

Nineteen studies (31 patients) were included. Mean maternal age was 33.0 ± 4.8 years. The most common indication was complex regional pain syndrome (18/31, 58.1%), followed by failed back surgery syndrome (6/31, 19.4%). All systems were implanted prior to pregnancy. Device-related complications were uncommon, with rare lead migration and fracture and no reported infections or explantations. Most pregnancies maintained effective stimulation with infrequent reprogramming. Neuraxial anesthesia and vaginal delivery were generally feasible, and cesarean delivery was not attributable to device location. Gestational age and neonatal outcomes were reassuring, with term delivery predominating, normal birthweights, favorable Apgar scores, and no neonatal deaths. No consistent pattern of maternal or fetal complications attributable to SCS was identified.

Available evidence suggests that SCS is well tolerated in pregnancy, with low device-related risk and favorable maternal and neonatal outcomes.