Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom

• Published in: Blood 2013-05, Vol.121 (19), p.3953-3961
• Main Authors: Sultan, Alyshah Abdul, Tata, Laila J., West, Joe, Fiaschi, Linda, Fleming, Kate M., Nelson-Piercy, Catherine, Grainge, Matthew J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cohort Studies; Female; Humans; Incidence; Population; Pregnancy; Pregnancy Complications, Cardiovascular - epidemiology; Puerperal Disorders - epidemiology; Puerperal Disorders - etiology; Risk Factors; Time Factors; United Kingdom - epidemiology; Venous Thromboembolism - epidemiology; Young Adult
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2012-11-469551

Knowledge of the absolute risk (AR) for venous thromboembolism (VTE) in women around pregnancy and how potential risk factors modify this risk is crucial in identifying women who would benefit most from thromboprophylaxis. We examined a large primary care database containing 376 154 pregnancies ending in live birth or stillbirth from women aged 15 to 44 years between 1995 and 2009 and assessed the effect of risk factors on the incidence of antepartum and postpartum VTE in terms of ARs and incidence rate ratios (IRR), using Poisson regression. During antepartum, varicose veins, inflammatory bowel disease (IBD), urinary tract infection, and preexisting diabetes were associated with an increased risk for VTE (ARs, ≥139/100 000 person-years; IRRs, ≥1.8/100 000 person-years). Postpartum, the strongest risk factor was stillbirth (AR, 2444/100 000 person-years; IRR, 6.2/100 000 person-years), followed by medical comorbidities (including varicose veins, IBD, or cardiac disease), a body mass index (BMI) of 30 kg/m2 or higher, obstetric hemorrhage, preterm delivery, and caesarean section (ARs, ≥637/100 000 person-years; IRRs, ≥1.9/100 000 person-years). Our findings suggest that VTE risk varies modestly by recognized factors during antepartum; however, women with stillbirths, preterm births, obstetric hemorrhage, caesarean section delivery, medical comorbidities, or a BMI of 30 kg/m2 or higher are at much higher risk for VTE after delivery. These risk factors should receive careful consideration when assessing the potential need for thromboprophylaxis during the postpartum period. •Antepartum, we found that established risk factors only had a modest effect on rates of VTE.•Postpartum, we found that among other factors, women with stillbirth or preterm birth had high rates of VTE.