{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:05:06Z","timestamp":1784873106469,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFB4702800"],"award-info":[{"award-number":["2022YFB4702800"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82202244"],"award-info":[{"award-number":["82202244"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82101356"],"award-info":[{"award-number":["82101356"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cerebral arteriovenous malformations (AVM) pose a significant risk during pregnancy because of hormonal changes and increased hemodynamic stress. This study aims to assess the risk of AVM rupture during pregnancy and puerperium and to identify risk factors associated with rupture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included 588 women with AVMs and a history of pregnancy, enrolled from a nationwide registry in China between August 2011 and August 2021. A case\u2010crossover design was used to compare rupture risk during pregnancy, puerperium, and non\u2010pregnancy periods, adjusting for clinical and morphological factors. Multivariable logistic regression analysis identified independent risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The risk of AVM rupture was significantly higher during pregnancy compared to non\u2010pregnancy periods (4.5% vs 1.6%; risk ratio [RR], 3.1; 95% confidence interval [CI], 2.3\u20134.2;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The risk was particularly elevated during the second and third trimesters. Key factors independently associated with increased rupture risk included adolescent or advanced\u2010age pregnancy (adolescent \u226419\u2009years or advanced \u226535\u2009years, odds ratio [OR], 8.32; 95% CI, 2.09\u201328.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), a history of AVM rupture before pregnancy (OR, 4.20; 95% CI, 1.37\u201311.40;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), diffuse nidus (OR, 2.32; 95% CI, 1.07\u20135.12;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033), and multifetal pregnancy (OR 18.31; 95% CI, 1.14\u2013293.27;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Pregnancy substantially increases the risk of AVM rupture, particularly during the second and third trimesters and compared to pre\u2010first pregnancy periods. Risk factors such as adolescent or advanced\u2010age pregnancy and multifetal pregnancy further increase the risk. These findings underscore the importance of tailored management during pregnancy for optimizing maternal and fetal outcomes. ANN NEUROL 2025;98:1136\u20131145<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.70014","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T11:19:47Z","timestamp":1754565587000},"page":"1136-1145","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Elevated Risk of Cerebral Arteriovenous Malformation Rupture during Pregnancy and Puerperium"],"prefix":"10.1002","volume":"98","author":[{"given":"Haibin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9155-038X","authenticated-orcid":false,"given":"Heze","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqing","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Beijing Tiantan Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine  Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruinan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University  Beijing 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