{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:35:24Z","timestamp":1793230524391,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,7,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The association between pregnancy and the risk of symptomatic hemorrhage (SH) in brainstem cavernous malformations remains uncertain. We aimed to quantify the risk of pregnancy\u2010associated SH in women with brainstem cavernous malformations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed women with brainstem cavernous malformations in a prospective registry (2016\u20132022) experiencing pregnancy after enrollment. Follow\u2010up was divided into pregnancy\u2010associated segments (pregnancy plus \u22646\u2009weeks postpartum or postabortion) and nonpregnant segments. Primary analysis used case\u2010crossover models; propensity score\u2010matched analyses assessed robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among 63 women (median age, 30.0\u2009years), 53 (84.1%) had bled before enrollment, including 45 (71.4%) with SH in the preceding year. Prospectively, they contributed 72 pregnancies and 371.7 patient\u2010years, observing 34 SHs. The pregnancy annual SH rate was 20.4% versus 7.2% nonpregnant (adjusted incidence rate ratio: 2.56, 95% CI, 1.11\u20135.93;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.028). Trimester\u2010specific and postpartum annual SH rates were 5.9%, 16.8%, 34.6%, and 38.3%; risk significantly increased only during the third trimester (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.004) and postpartum (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.007). This pregnancy effect was confined to segments with SH in the preceding year (annual SH rates 46.7% versus 9.4%;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.007), which was an independent risk factor. Propensity score\u2010matched analyses yielded consistent results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Pregnancy is associated with an elevated SH risk in women with brainstem cavernous malformations, specifically among those with SH in the preceding year. Because of selection bias, generalizability to asymptomatic or incidental lesions is limited, warranting cautious extrapolation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.chictr.org.cn\">www.chictr.org.cn<\/jats:ext-link>\n                      ; Unique Identifier: ChiCTR\u2010POC\u201017011575.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.049628","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:56:50Z","timestamp":1784285810000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Pregnancy and Symptomatic Hemorrhage in Women With Brainstem Cavernous Malformations and Bleeding in the Preceding Year: A Prospective Multicenter Study"],"prefix":"10.1161","volume":"15","author":[{"given":"Jing\u2010Jie","family":"Zheng","sequence":"first","affiliation":[{"name":"Beijing Chaoyang Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8337-4670","authenticated-orcid":false,"given":"Jian\u2010Cong","family":"Weng","sequence":"additional","affiliation":[{"name":"China\u2010Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Ying","family":"Xu","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Guo","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei\u2010Cheng","family":"Yuan","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui\u2010Jun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi\u2010Hong","family":"Zhu","sequence":"additional","affiliation":[{"name":"Sichuan University West China Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan\u2010Pan","family":"Liu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Kong","sequence":"additional","affiliation":[{"name":"Qingdao Municipal Hospital, Qingdao University","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhou","sequence":"additional","affiliation":[{"name":"The First People's Hospital of Lianyungang","place":["Lianyungang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao\u2010Yu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Chaoyang Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Jun","family":"Zeng","sequence":"additional","affiliation":[{"name":"The Second People's Hospital of Shenzhen","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ze\u2010Yu","family":"Wu","sequence":"additional","affiliation":[{"name":"The Affiliated Hospital of Qingdao University","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Ren","sequence":"additional","affiliation":[{"name":"Beijing Electric Power Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Peking University Binhai Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong\u2010Jun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Puhua Hospital, Dongcheng District","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4923-2905","authenticated-orcid":false,"given":"Jiu\u2010Luan","family":"Lin","sequence":"additional","affiliation":[{"name":"Tsinghua University, Yuquan Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo\u2010Han","family":"Yao","sequence":"additional","affiliation":[{"name":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun\u2010Peng","family":"Ma","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lai\u2010Rong","family":"Song","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai\u2010Bing","family":"Tian","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3763-1095","authenticated-orcid":false,"given":"Jun\u2010Ting","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4985-4889","authenticated-orcid":false,"given":"Zhen","family":"Wu","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010Rong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Beijing Chaoyang Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan\u2010Bing","family":"Yu","sequence":"additional","affiliation":[{"name":"China\u2010Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0629-0742","authenticated-orcid":false,"given":"Da","family":"Li","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70004-2"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318248de9b"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000343668.44288.18"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/2011.3.FOCUS1165"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00303-8"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.12.JNS192856"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2020-000608"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000009730"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.035338"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002701"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.031761"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.3.JNS132537"},{"key":"e_1_3_2_14_2","first-page":"1166","article-title":"The natural history of cavernous malformations: a prospective study of 68 patients","volume":"44","author":"Moriarity JL","year":"1999","unstructured":"Moriarity JL, Wetzel M, Clatterbuck RE, Javedan S, Sheppard JM, Hoenig\u2010Rigamonti K, Crone NE, Breiter SN, Lee RR, Rigamonti D. The natural history of cavernous malformations: a prospective study of 68 patients. Neurosurgery. 1999;44:1166\u20131171.","journal-title":"Neurosurgery"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1999.90.1.0050"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000206888"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00122-4"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2019.11.005"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1991.75.5.0709"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2020.101927"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.809417"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199604000-00006"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.10.092"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0090-3019(03)00251-9"},{"key":"e_1_3_2_25_2","first-page":"88","article-title":"Cavernous malformations of the brainstem","volume":"55","author":"Haque R","year":"2008","unstructured":"Haque R, Kellner CP, Solomon RA. Cavernous malformations of the brainstem. Clin Neurosurg. 2008;55:88\u201396.","journal-title":"Clin Neurosurg"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.3171\/2009.3.JNS081160"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1590\/s0004-282x2009000500030"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-011-1061-y"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2012.02.040"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e31825fd0dc"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/0883073812457459"},{"key":"e_1_3_2_32_2","first-page":"542","article-title":"Hemorrhagic stroke resulting from venous malformation at 20\u2009weeks of pregnancy","volume":"16","author":"Ulrich ND","year":"2016","unstructured":"Ulrich ND, Lapeyre ER, Moore RC. Hemorrhagic stroke resulting from venous malformation at 20\u2009weeks of pregnancy. Ochsner J. 2016;16:542\u2013544.","journal-title":"Ochsner J"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.3171\/2012.8.JNS12241"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000003459"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1487808"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200107000-00002"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2015.08.020"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2021.10.013"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.126.049628","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:08:52Z","timestamp":1785254932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.126.049628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":37,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2026,7,21]]}},"alternative-id":["10.1161\/JAHA.126.049628"],"URL":"https:\/\/doi.org\/10.1161\/jaha.126.049628","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"assertion":[{"value":"2026-01-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e049628"}}