Porras Jose L, Yang Wuyang, Philadelphia Eunice, Law Jody, Garzon-Muvdi Tomas, Caplan Justin M, Colby Geoffrey P, Coon Alexander L, Tamargo Rafael J, Huang Judy
From the Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Stroke. 2017 Jun;48(6):1507-1513. doi: 10.1161/STROKEAHA.117.016828. Epub 2017 May 9.
Conclusions reached in existing literature about risk of arteriovenous malformation (AVM) hemorrhage during pregnancy are controversial. This study compares the risk of hemorrhage in pregnant and nonpregnant female patients with AVM in a North American cohort.
We retrospectively reviewed female patients with AVM evaluated from 1990 to 2015. Exposure period for pregnancy and puerperium was calculated as 40 and 6 weeks, respectively, for each full-term pregnancy and 6 weeks for each abortion. Hemorrhage events and patient-years were calculated during an exposure period (pregnancy and puerperium), and a nonexposure period defined as either the interval from birth until AVM obliteration or until last follow-up after subtracting exposure period. Poisson rate ratio test was used to compare rate of hemorrhage between exposure and nonexposure periods.
For 270 female patients with AVM, mean age was 35.0±19.6 years, and race distribution was white (n=165, 61.1%), black (n=59, 21.9%), Hispanic (n=9, 3.3%), Asian (n=6, 2.2%), and other (n=31, 11.5%). From 191 total pregnancies occurring before AVM obliteration, there were 175 (91.6%) term deliveries and 16 (8.4%) abortions. Overall annual hemorrhage rate for 149 total hemorrhages during an average of 11 097 patient-years was 1.34%. There were 140 hemorrhages in nonexposed women and 9 hemorrhages in pregnant women, translating to an annual hemorrhage rate of 1.3% in nonpregnant women versus 5.7% in pregnant women (<0.001). Identical analysis for reproductive age patients (15-50) demonstrated a rate of 1.3% versus 7.0% (<0.001).
Our results conflict with those from a recent study describing no increased rate of rupture during pregnancy. This difference may reflect unique population attributes influencing brain AVM hemorrhage during pregnancy.
现有文献中关于妊娠期动静脉畸形（AVM）出血风险的结论存在争议。本研究比较了北美队列中患有AVM的妊娠女性和非妊娠女性患者的出血风险。
我们回顾性分析了1990年至2015年期间接受评估的患有AVM的女性患者。每次足月妊娠的孕期和产褥期暴露时间分别计算为40周和6周，每次流产的暴露时间为6周。在暴露期（孕期和产褥期）以及非暴露期（定义为从出生到AVM闭塞或减去暴露期后的最后随访之间的时间段）计算出血事件和患者年数。使用泊松率比检验比较暴露期和非暴露期之间的出血率。
270例患有AVM的女性患者，平均年龄为35.0±19.6岁，种族分布为白人（n = 165，61.1%）、黑人（n = 59，21.9%）、西班牙裔（n = 9，3.3%）、亚洲人（n = 6，2.2%）和其他（n = 31，11.5%）。在AVM闭塞前发生的191次妊娠中，有175次（91.6%）足月分娩和16次（8.4%）流产。在平均11097患者年期间，149次出血的总体年出血率为1.34%。未暴露女性中有140次出血，妊娠女性中有9次出血，非妊娠女性的年出血率为1.3%，而妊娠女性为5.7%（<0.001）。对育龄患者（15 - 50岁）进行的相同分析显示，出血率分别为1.3%和7.0%（<0.001）。
我们的结果与最近一项描述妊娠期破裂率未增加的研究结果相矛盾。这种差异可能反映了影响妊娠期脑AVM出血的独特人群特征。
