Trends in venous thromboembolism among pregnancy-related hospitalizations, United States, 1994-2009

Abstract

OBJECTIVE-The purpose of this study was to evaluate national trends in the rate of pregnancyrelated hospitalizations for venous thromboembolism (VTE) from 1994-2009 and to estimate the prevalence of comorbid conditions among these hospitalizations.STUDY DESIGN-An estimated 64,413,973 pregnancy-related hospitalizations among women 15-44 years old were identified in the 1994-2009 Nationwide Inpatient Sample. Trends in VTEassociated pregnancy hospitalizations were evaluated with the use of variance-weighted least squares regression. Chi-square tests were used to assess changes in prevalence of demographics and comorbid conditions, and multivariable logistic regression was used to evaluate the likelihood of VTE during the study period after adjustment for comorbid conditions. Antepartum, delivery, and postpartum hospitalizations were evaluated separately and reported in 4-year increments. [1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007][2008][2009], there was a 14% increase in the rate of overall VTE-associated pregnancy hospitalizations; antepartum and postpartum hospitalizations with VTE increased by 17% and 47%, respectively. Between 199417% and 47%, respectively. Between -199717% and 47%, respectively. Between and 200617% and 47%, respectively. Between -2009, the prevalence of hypertension and obesity doubled among all VTE-associated pregnancy hospitalizations; significant increases in diabetes mellitus and heart disease were also noted. A temporal increase in the likelihood of a VTE diagnosis in pregnancy was observed for antepartum hospitalizations from 2006-2009 when compared with 1994-1997 (adjusted odds ratio, 1.62; 95% confidence interval, 1.48-1.78). RESULTS-FromCONCLUSION-There has been an upward trend in VTE-associated pregnancy hospitalizations from 1994-2009 with concomitant increases in comorbid conditions. Clinicians should have a heightened awareness of the risk of VTE among pregnant women, particularly among those with comorbid conditions, and should have a low threshold for evaluation in women with symptoms or signs of VTE.

Impact de l’âge maternel avancé sur les profils de coagulation thrombo-élastographique du péripatum: une étude observationnelle prospective exploratoire

“…In several population-wide studies, women aged C 35 yr were observed to be at increased risk of pregnancy-related VTE compared with women aged \ 35 yr. [4][5][6] Advanced maternal age women 35-44 yr of age may also be at increased risk of postpartum VTE compared with women 15-24 yr of age. 25 Nevertheless, data from other studies suggest that this association should be questioned. In a Danish cohort study investigating pregnancy-associated VTE, maternal age was not associated with an increased risk of VTE, and no interaction was reported between maternal age and gestational age.…”

“…The median [IQR] ages of women were 38 [37][38][39][40][41] yr and 29 [25][26][27][28][29][30][31][32][33][34] yr in the AMA and non-AMA groups, respectively (Table 1). Other maternal demographic and obstetric characteristics were similar in both groups (Table 1).…”

“…Nous avons utilisé un modèle de régression linéaire d'effets mélangés (SAS Ò PROC MIXED) pour évaluer les différences entre les groupes concernant les résultats individuels des paramètres thrombo-élastographiques et de coagulation. Résultats Les âges médians (intervalle interquartile) des femmes étaient de 38 (37-41) ans et 29 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34) ans pour, respectivement, les groupes AMA et non AMA (P \ 0,001). Nous n'avons observé aucun effet statistiquement significatif de groupe d'étude sur les paramètres thrombo-élastographiques ou sur les paramètres de laboratoire de la coagulation.…”

“…The aim of this prospective observational study was to compare peripartum thromboelastography parameters of AMA and non-AMA women undergoing elective Cesarean delivery (CD). [25][26][27][28][29][30][31][32][33][34] yr in the AMA and non-AMA groups, respectively (P \ 0.001). We observed no statistically significant effect of study group on any thromboelastographic or laboratory coagulation parameters.…”

Postpartum venous thromboembolic risk: one size may not fit all

“…3,4 Relative to nonpregnant, reproductive age women, pregnant women have a 4-fold higher risk of VTE, 4 and postpartum risk is further increased, with estimates ranging from 9-fold to 84-fold higher. 4,5 Clinical guidelines addressing VTE risk and thromboprophylaxis aim to target high-risk populations to effectively prevent these complications. 6,7 However, the data on which guidelines have been developed rely on observational studies, extrapolation from other populations, and expert opinion.…”