Pregnancy and the possibility of triggering a brain aneurysm: Potential hazards and signs to look out for
Brain aneurysms, weakened spots in the arteries of the brain, can pose a significant risk during pregnancy. This medical condition, which can be life-threatening, is relatively rare but requires careful monitoring and individualized risk assessment.
A ruptured brain aneurysm is the most common cause of subarachnoid hemorrhage (SAH) – bleeding around the brain – during pregnancy. SAH is five times more common in pregnant individuals than in nonpregnant individuals. If a brain aneurysm ruptures, it can bleed into the surrounding brain tissue, a condition known as a hemorrhage. This bleeding within the skull is not uncommon in pregnant individuals with a ruptured brain aneurysm.
The frequency of ruptured aneurysms in pregnancy ranges from 3-11 per 100,000 pregnancies. However, detailed prevalence data specific to pregnancy are not available, as neurological vascular conditions like intracranial aneurysms are considered rare.
The risk of a ruptured brain aneurysm is higher in the third trimester and for 6 weeks after giving birth. This increased risk is attributed to changes in hormones and blood flow during pregnancy, as well as pregnancy water retention and the subsequent increase in blood volume and cardiac output. In particular, cardiac output, the amount of blood the heart pumps out, increases by 30-50% in pregnancy, reaching its peak in the third trimester. An increase in estrogen in pregnancy may also increase blood flow in the brain.
Surgical treatment for a ruptured brain aneurysm can help improve outcomes and lower fetal mortality rates compared to receiving medication only. Surgical clipping and endovascular coiling are treatment options for brain aneurysms in pregnancy. In some cases, a diagnosis of an aneurysm in later pregnancy or severe symptoms may result in an emergency cesarean section. If a person has surgical clipping of an aneurysm, the pregnancy can continue to full term with a vaginal delivery.
To diagnose a brain aneurysm in pregnancy, doctors use various methods, including blood pressure tests, blood tests, lumbar puncture, MRI scan, CT scan of the skull, CT angiography, and taking steps to protect the abdominal area during scans. Untreated brain aneurysms can lead to a recurring bleed in the brain, with maternal mortality rates between 50% and 68%.
It's important to note that having a medical history of high blood pressure, diabetes, bleeding disorder, thrombocytopenia, or substance misuse may increase the risk of a brain aneurysm in pregnancy. Additionally, some research suggests that Black or Asian people may be more likely to experience bleeding in the brain due to a ruptured brain aneurysm than white people.
In conclusion, while brain aneurysms during pregnancy are relatively rare, they pose a significant risk and require careful monitoring. Pregnant individuals should be aware of the signs and symptoms of a ruptured brain aneurysm, such as severe headache, neck pain, nausea, vomiting, and vision changes, and seek immediate medical attention if they experience these symptoms. If a CT scan of the head or chest area during pregnancy is necessary, there is no risk of radiation to the fetus.
