In a recent study, patients with shunt complications rarely had poor obstetric outcomes, and no cases of shunt malfunction were reported.
Shunt malfunctions do not occur often during pregnancy, and most patients with shunt complications during pregnancy experience favorable obstetric outcomes, according to a recent study published in JAMA Network Open.1
Concerns have arisen about the risks of cerebrospinal fluid (CSF) diversion shunts during pregnancy among reproductive-aged women with shunted hydrocephalus. Currently available data has indicated shunt failure rates of 10% to 50%, which may increase worry among expectant patients.1
In a review posted in 2020, the safety of pregnancy in ventriculoperitoneal (VP) shunt-dependent women was evaluated.2 Studies published between 1950 and 2019 were identified from the MEDLINE, EMBASE, Cochrane Library, Web of Science, Google Scholar, and ClinicalTrial.gov databases.
The review reported antepartum complications in 50% of cases. Of symptoms, 73.7% were increased intracranial pressure, making it the most common. Cerebrospinal fluid aspiration was used to resolve 26.3% of cases, but researchers recommended a multidisciplinary approach for managing VP shunts during pregnancy.2
To evaluate the safety of CSF shunts during pregnancy, investigators conducted a retrospective and multicenter cohort study.1 The study included data about obstetrical deliveries between 1989 and 2023 from a clinical research repository.
Participants were eligible if they had a billing code for childbirth, medical record of a CSF shunt, and hydrocephalus. A delivery note was also necessary, and all included patients had shunt placement before pregnancy.1
Relevant data included shunt-related symptoms, revisions, obstetrical complications, delivery characteristics, and infant outcomes. Both prenatal and postnatal data through 6 months postpartum was extracted.1
Safety was defined by investigators as, “the absence of shunt-related complications and adverse patient- or infant-related outcomes.” The Wilcoxon rank sum and Fisher exact tests were used to evaluate factors linked to shunt failure.1
There were 85 pregnancies in 60 patients delivering 90 infants included in the final analysis. Congenital anomalies were reported in 30% of included pregnancies and intracranial tumors in 28.3%, making them the most common hydrocephalus etiologies.1
A VP shunt was reported in 95% of patients, with 66.7% of these patients having the shunt placed during childhood. Two patients reported more than 1 shunt revision.1
Worry about their shunts was reported by 35% of patients during pregnancy, and 34% discussed risks of pregnancy and delivery after referral to neurosurgery. There were 12 pregnancies with symptoms that led to concerns for malformation, with 2 cases undergoing neuroimaging and 2 receiving shunt-taps. Shunt malfunction was ruled out in all cases.1
Obstetrical complications included preterm birth in 17.6% of patients and gestational diabetes in 10.6%. These rates remained low, and data was not available to compare to a nonshunted population. Sixty percent of births were performed through cesarean delivery, and only 1 infant died to complications unrelated to the mother’s shunt status.1
Shunt-related symptoms within 6 months postpartum were reported in 16.5% of deliveries, with 5.9% having confirmed malfunctions and revisions. Patients with adult shunt placement were more likely to experience postpartum malfunctions, with an odds ratio of 4.2.1
These results indicate no shunt malfunctions during pregnancy among patients with shunt placement, alongside favorable obstetric outcomes. However, the study was limited by a restricted study population of only patients delivering with a shunt. Investigators recommended additional research about the risk of CSF shunting on reproductive health.1
References
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