Outcomes of Spinal Cord Stimulation in Pregnancy: Insights from Propensity-matched Global Cohorts

Introduction: Spinal cord stimulation (SCS) is increasingly used for refractory pain in women of reproductive age, yet data on maternal outcomes during pregnancy remain limited. Understanding the outcomes associated with SCS in pregnancy compared both to non-pregnant SCS patients and to pregnant patients without SCS is essential for counseling and management.

Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, which aggregates de-identified electronic health records from 154 healthcare organizations. Three cohorts were defined: (1) SCS – pregnant (pregnant women undergoing SCS), (2) SCS – non-pregnant (non-pregnant women undergoing SCS), and (3) No SCS – pregnant (pregnant women without SCS). The index event was the earliest date meeting cohort criteria. Outcomes were assessed from 1 day to 365 days post-index and included 10 predefined outcomes: preterm labor, preterm birth, preeclampsia/eclampsia, placental abruption, cesarean delivery, postpartum hemorrhage, unspecified pain, opioid use, opioid abuse, and falls. Analyses included 1:1 propensity score matching (nearest neighbor, no replacement) on demographics, comorbidities, and obstetric history. We calculated risk differences (RD), risk ratios (RR), odds ratios (OR), and 95% confidence intervals (CI); p-values < 0.05 were considered significant.

Results: After matching, 2,396 patients per group were included in the SCS – pregnant vs. SCS – not pregnant analysis. Pregnant women with SCS had higher risks of opioid use (RD: 5.1%, RR: 1.11, p< 0.001), and falls (RD: 1.3%, RR: 2.07, p=0.001), but lower risk of pain (RD: -1.4%, RR: 0.67, p=0.010).

In the SCS – pregnant vs. No SCS – pregnant analysis, 1,657 patients per group were matched. Preeclampsia/eclampsia was significantly less frequent in the SCS group (RD: -7.4%, RR: 0.29, p< 0.001), while pain was more common (RD: 1.4%, RR: 1.71, p=0.011). No significant differences were observed for preterm labor, preterm birth, placental abruption, cesarean delivery, postpartum hemorrhage, opioid use, opioid abuse, or falls.

Conclusion: In matched analyses, SCS use during pregnancy was associated with higher risk of pain compared to non-pregnant SCS patients, but a lower risk of preeclampsia/eclampsia compared to pregnant women without SCS. These findings highlight the need for individualized risk counseling and further prospective studies to clarify causal pathways and optimize care in this population.