The purpose of this study was to systematically assess and synthesize the world literature on risk factors for the onset and natural progression of
hydrocephalus, thereby providing a basis for policy makers to identify appropriate risk management measures to mitigate the burden of disease in Canada. Evidence for risk factors was limited for both onset and progression. Two meta-analyses that examined a risk factor for onset met the inclusion criteria. One found a significant protective effect of prenatal
vitamins among case control studies, but not cohort/randomized controlled trials (RCTs). The second found
maternal obesity to be a significant risk factor for
congenital hydrocephalus. Significant risk factors among 25 observational studies included:
biological (multiple births, maternal parity,
common cold with
fever, maternal
thyroid disease, family history,
preterm birth,
hypertension,
ischemic heart disease, ischemic ECG changes, higher cerebrospinal fluid
protein concentration following
vestibular schwannoma); lifestyle (
maternal obesity,
high-density lipoprotein (
HDL) cholesterol, maternal diabetes, maternal age), healthcare-related (
caesarean section, interhospital transfer, drainage duration following
subarachnoid hemorrhage, proximity to midline for
craniectomy following
traumatic brain injury);
pharmaceutical (prenatal exposure to:
tribenoside,
metronidazole,
anesthesia,
opioids); and environmental (altitude, paternal occupation). Three studies reported on genetic risk factors: no significant associations were found. There are major gaps in the literature with respect to risk factors for the natural progression of
hydrocephalus. Only two observational studies were included and three factors reported. Many risk factors for the onset of
hydrocephalus have been studied; for most, evidence remains limited or inconclusive. More work is needed to confirm any causal associations and better inform policy.