Venous thromboembolism in pregnant and puerperal women in Denmark 1995–2005

 

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Summary

Venous thromboembolism (VTE) is the leading cause of maternal death in the Western world, and the risk increases during pregnancy and puerperal period. It was the objective of the present study to estimate the absolute and the relative risk of VTE at different weeks of gestation and in the postnatal period as compared to non-pregnant women. This was a historical controlled national cohort study. The National Registry of Patients identified relevant diagnoses. These data were linked to The National Registry of Medical Products Statistics for information about current use of oral contraceptives. Danish women 15 to 49 years old during the period January 1995 through December 2005 were included in the study. In total 819,751 pregnant women were identified of whom 727 had a diagnosis of VTE. The absolute risk of VTE per 10,000 pregnancy-years increased from 4.1 (95% CI, 3.2 to 5.2) during week 1–11 up to 59.0 (95% CI: 46.1 to 76.4) in week 40 and decreased in the puerperal period from 60.0 (95% CI:47.2–76.4) during the first week after birth to 2.1 (95% CI:1.1 to 4.2) during week 9–12 after birth. Compared with non-pregnant women, the incidence rate ratio rose from 1.5 (95% CI:1.1 to1.9) in week 1–11, to 21.0 (95%CI16.7 to 27.4) in week 40 and 21.5 (95% CI:16.8 to 27.6) in the first week after delivery, declining to 3.8 (95% CI:2.5 to 5.8) 5–6 weeks after delivery. In conclusion, the risk of VTE increases almost exponentially through pregnancy and reaches maximum just after delivery and is no longer significantly increased six weeks after delivery.

• References

• 1 Bodker B, Hvidman L, Weber T. et al. Maternal deaths in Denmark 2002-2006. Acta Obstet Gynecol Scand 2009; 88: 556-562.
  CrossrefPubMedGoogle Scholar
• 2 Hellgren M, Blomback M. Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. I. Normal condition. Gynecol Obstet Invest 1981; 12: 141-154.
  CrossrefPubMedGoogle Scholar
• 3 Alving BM, Comp PC. Recent advances in understanding clotting and evaluating patients with recurrent thrombosis. Am J Obstet Gynecol 1992; 167: 1184-1191.
  CrossrefPubMedGoogle Scholar
• 4 Chunilal SD, Bates SM. Venous thromboembolism in pregnancy: diagnosis, management and prevention. Thromb Haemost 2009; 101: 428-438.
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Brown HL, Hiett AK. Deep vein thrombosis and pulmonary embolism in pregnancy: diagnosis, complications, and management. Clin Obstet Gynecol 2010; 53: 345-359.
  CrossrefPubMedGoogle Scholar
• 6 Gherman RB, Goodwin TM, Leung B. et al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999; 94: 730-734.
  PubMedGoogle Scholar
• 7 Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium–a register-based case-control study. Am J Obstet Gynecol 2008; 198: 233.e1-233.e7.
  CrossrefPubMedGoogle Scholar
• 8 Heit JA, Kobbervig CE, James AH. et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143: 697-706.
  CrossrefPubMedGoogle Scholar
• 9 Ray JG, Chan WS. Deep vein thrombosis during pregnancy and the puerperium: a meta-analysis of the period of risk and the leg of presentation. Obstet Gynecol Surv 1999; 54: 265-271.
  CrossrefPubMedGoogle Scholar
• 10 Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scott Med J 1996; 41: 83-86.
  CrossrefPubMedGoogle Scholar
• 11 McColl MD, Ramsay JE, Tait RC. et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997; 78: 1183-1188.
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Blanco-Molina A, Rota LL, Di Micco P. et al. Venous thromboembolism during pregnancy, postpartum or during contraceptive use. Thromb Haemost 2010; 103: 306-311.
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 White RH, Chan WS, Zhou H. et al. Recurrent venous thromboembolism after pregnancy-associated versus unprovoked thromboembolism. Thromb Haemost 2008; 100: 246-252.
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Andersen BS, Steffensen FH, Sorensen HT. et al. The cumulative incidence of venous thromboembolism during pregnancy and puerperium–an 11 year Danish population-based study of 63,300 pregnancies. Acta Obstet Gynecol Scand 1998; 77: 170-173.
  CrossrefPubMedGoogle Scholar
• 15 Pomp ER, Lenselink AM, Rosendaal FR. et al. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 2008; 6: 632-637.
  CrossrefPubMedGoogle Scholar
• 16 Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999; 353: 1258-1265.
  CrossrefPubMedGoogle Scholar
• 17 Jacobsen AF, Skjeldestad FE, Sandset PM. Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost 2008; 6: 905-912.
  CrossrefPubMedGoogle Scholar
• 18 Larsen TB, Johnsen SP, Moller CI. et al. A review of medical records and discharge summary data found moderate to high predictive values of discharge diagnoses of venous thromboembolism during pregnancy and postpartum. J Clin Epidemiol 2005; 58: 316-319.
  CrossrefPubMedGoogle Scholar
• 19 White RH, Brickner LA, Scannell KA. ICD-9-CM codes poorly indentified venous thromboembolism during pregnancy. J Clin Epidemiol 2004; 57: 985-988.
  CrossrefPubMedGoogle Scholar