Outcome of pregnancies complicated by idiopathic intracranial hypertension

Abstract

Objective: Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is relatively uncommon in the general population, but has an increased incidence in reproductive-aged women. We sought to determine the obstetric and neurosurgical outcomes of pregnant women with idiopathic hypertension.Methods: Sixteen consecutive pregnancies complicated by idiopathic intracranial hypertension between January 1990 and July 1999 were included in this retrospective study. The frequency of symptoms of increased intracranial pressure and adverse obstetrical outcomes were determined in these patients. The χ2 test was used for statistical analysis.Results: Of 16 patients, 12 (75%) had a BMI ≥ 29 kg/m2. Two patients had a cerebrospinal fluid shunt (ventriculo-peritoneal in one, lumbo-peritoneal in the other). Four pregnancies ended in therapeutic abortion, one of which was prompted by severe progressive disease. Of the 12 patients whose pregnancies progressed to viability, 5 (42%) experienced worsening of their symptoms, at a mean gestational age of 10 ± 1.1 weeks. There were two perinatal deaths: one stillbirth from abruptio placentae at term and one neonatal death following the birth of a growth-restricted 29-week fetus. Both patients with a cerebrospinal fluid shunt experienced poor obstetric outcome—need for therapeutic abortion in one and term fetal demise in the other. In the nonshunted patients, there was one neonatal death (2/2 versus 1/14 poor obstetrical outcome in shunted versus nonshunted patients, P <0.05). No patients had exacerbation of symptoms during labor or the puerperium.Conclusions: An association with obesity was observed. Symptom recurrences were common, but usually responded well to conservative therapy. There may be an association between adverse pregnancy outcome and prior placement of a cerebrospinal fluid shunt.