Shunt complications uncommon, often safe during pregnancy

Shunt complications not found contraindicating to pregnancy | Image Credit: © Rido - © Rido - stock.adobe.com.

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

1. Discenza M, Papadakis JE, Little S, Madsen JR. Safety of pregnancy and delivery with shunted hydrocephalus. JAMA Netw Open. 2024;7(9):e2434688. doi:10.1001/jamanetworkopen.2024.34688
2. Al-Saadi TD, Glisic M, Al Sharqi A, et al. Safety of pregnancy in ventriculoperitoneal shunt dependent women: meta-analysis and systematic review of the literature. Neurol India. 2020;68(3):548-554. doi:10.4103/0028-3886.288995