Idiopathic intracranial hypertension and pregnancy: outcomes in previously shunted women

Objective Idiopathic intracranial hypertension (IIH) typically affects obese women of reproductive age. Ventriculoperitoneal (VP) shunting is an established surgical treatment for severe or medically refractory cases. There is limited knowledge regarding the management of these patients when they become pregnant. Here, we report our multidisciplinary experience in this subgroup of IIH. Methods Our database on IIH was retrospectively screened for women who were diagnosed and treated with a VP shunt from 2005 to 2025. We analyzed onset of IIH in relation to pregnancy, number of pregnancies resulting in live births before and after VP shunting, and the mode of delivery. Results Overall 61 women with IIH underwent VP shunting during the study period. Nine women had 12 pregnancies resulting in live births at a median of 40.5 months after VP shunting (range 6–108). Onset of IIH was not related to the occurrence of pregnancies in all but one patient. 9/12 pregnancies resulted in vaginal delivery. Adjustment of the shunt valve was not required in these patients. One patient experienced progressive visual loss refractory to acetazolamide treatment during the first trimester. VP shunting at 11 weeks of gestation facilitated stabilization of her visual symptoms and delivery via elective Caesarean section. There were no peripartum cases of infection or malfunction of the shunt system. Conclusions The complexity of IIH during pregnancy requires a multidisciplinary approach in order to achieve an optimal outcome. In our cohort of previously shunted IIH patients with programmable valves and gravitational units, neither the occurrence of a pregnancy nor a vaginal delivery increased the risk for disease recurrence or deterioration. In severe cases, VP shunting remains a treatment option during pregnancy when clinically indicated.