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From the Journals

Do Hydrocephalus Shunts Pose Less Pregnancy Risk Than Once Thought?

A 2024 study of 85 pregnancies found no shunt malfunctions during pregnancy and only a 5.9% postpartum revision rate, contradicting decades of data on shunt failure risks for pregnant women.

Conexiant

A study found lower rates of cerebrospinal fluid shunt complications during pregnancy in women with shunted hydrocephalus compared with previous literature. 

In the retrospective, multicenter cohort study, published in JAMA Network Open, investigators analyzed 85 pregnancies in 60 women with cerebrospinal fluid (CSF) shunts placed before pregnancy, resulting in the birth of 90 infants. They examined obstetrical deliveries from 1989 to 2023. The women were identified through medical records and billing codes, and data on neurosurgical and obstetrical outcomes through 6 months postpartum were extracted.

The study population represented 0.02% of 518,068 pregnancies. The most common hydrocephalus etiologies were congenital anomalies (30%) and intracranial tumors (28.3%). The median age at delivery was 32 years (interquartile range [IQR] = 29–34), and most patients (95%) had ventriculoperitoneal shunts.

Among the key findings were:

  • No shunt malfunctions occurred during pregnancy
  • Postpartum shunt revision rate was 5.9% within 6 months of delivery
  • Cesarean delivery rate was 60%, with 23.5% attributed to clinician concerns about the shunt
  • Preterm birth rate was 17.6%
  • Infant survival rate was 98.9%.

During pregnancy, 35% of patients expressed concerns about their shunts, and 34% were referred to neurosurgery for risk assessment. While symptoms concerning for malfunction occurred in 14.1% of pregnancies, including headaches and visual symptoms, all cases were ruled out after investigation.

Obstetrical outcomes were as follows:

  • Full-term deliveries (37 to 40 weeks): 82.4%
  • Preterm births: 17.6%
  • Cesarean deliveries: 60%, with 23.5% because of shunt-related concerns.

Postpartum, 16.5% of deliveries were associated with concern for shunt malfunction, including headaches and shunt pain. However, only 5.9% resulted in confirmed malfunctions requiring revision. The median time to malfunction was 3 months (IQR = 2–4).

Though there was a higher rate of postpartum malfunctions in women with adult shunt placement (odds ratio = 4.2, 95% confidence interval = 0.66–27.0, P = .13), the finding did not reach statistical significance.

The study's retrospective design precluded the assessment of fertility rates and the overall incidence of complications in all women with shunted hydrocephalus who become pregnant.

One investigator reported receiving personal fees from Anuncia Lifesciences SAB and Bionaut Laboratories from outside the submitted work. No other disclosures were reported.