Prepregnancy overweight and obesity and long-term risk of venous thromboembolism in women

Trend, clinical characteristics, and pregnancy outcomes of pregnancy associated venous thromboembolism: a retrospective analysis of nearly 10 years

BACKGROUND

Pregnancy-associated venous thromboembolism (PA-VTE) seriously threatens maternal health. We aimed to investigate the clinical characteristics, risk factors, treatments, and pregnancy outcomes to better prevent and treat PA-VTE.

METHODS

PA-VTE patients were selected from 171,898 women who were registered in the Department of Obstetrics of Fujian Maternity and Child Health Hospital from January 2014 to August 2023 and delivered to calculate the incidence. Clinical data were collected to retrospectively analyze the clinical characteristics, risk factors, treatments, and pregnancy outcomes of PA-VTE. Descriptive statistical analysis was used.

RESULTS

There were 122 cases of PA-VTE with an incidence of 0.71 per 1000 pregnancies; the incidence showed an upward trend and peaked in 2022 (1.24‰). Pregnant women accounted for 28.69% (35/122), the onset were 5-39+6 weeks and incidence increased with the increase of trimester, reaching the highest level in puerperium with 87 cases (71.31%). VTE was mainly found in the lower extremities (112/122); a few were found in cranial venous sinus (4/122), pelvic vein (1/122), and pulmonary embolism (PE) in five cases. 78.68% (96/122) had clinical manifestations. By Royal College of Obstetricians and Gynaecologists (RCOG) risk assessment scale, 45.71% (16/35) of antepartum patients had risk score ≥3 with a maximum of 9, distributed in eight cases in the first trimester, four cases in the second trimester, and four cases in the third trimester. Patients with risk score <3 all occurred in the second and third trimester. Primary risk factors included advanced maternal age (AMA), thrombophilia. All patients received anticoagulant therapy, and seven patients were placed inferior vena cava (IVC) filter in antepartum period. Except one case of abortion in PPROM, the rest continued pregnancy to 29+1 to 40 weeks, only one case of postpartum hemorrhage and one case of severe neonatal asphyxia. The onset time in puerperium was three hours to 28 days after delivery; 62.07% (54/87) patients were scored ≥2. The main risk factors included elective cesarean section, AMA, and preterm birth. Anticoagulant therapy was given after diagnosis; two cases were placed with IVC filter, one case was placed with left iliac vein stent and thrombolysis.

CONCLUSIONS

The incidence of PA-VTE showed an increasing trend over the past decade, predominantly occurring postpartum. Main risk factors included AMA, thrombophilia, preterm birth, and elective cesarean section. Higher risk scores correlated with earlier onset. Early risk assessment, appropriate prophylaxis, and standardized anticoagulation therapy resulted in favorable maternal and fetal outcomes, with temporary IVC filter placement being beneficial in selected cases.

Association Between Obesity and Thrombosis During Pregnancy and the Postpartum Period: A Case-Control Study From a Tertiary Care Center in Kerala, India

Background Obesity is postulated to be a high-risk factor for thrombosis along with the inherent hypercoagulability of pregnancy. The Confidential Review of Maternal Deaths (CRMD) found that thrombosis was one of the major causes of maternal deaths in Kerala. This study investigates the major risk factor - obesity and its association with thrombosis in our study setting, along with other risk factors. Obesity, being a modifiable risk factor, can thus be targeted to decrease maternal morbidity and mortality for a better pregnancy outcome. This study sought to examine the association between obesity and thrombosis during pregnancy and the postpartum period in a tertiary care center in Kerala, India, while also identifying other risk factors that may contribute to thrombotic events in this population. Methodology A hospital-based case-control study was conducted at Government Medical College, Thiruvananthapuram, Kerala, India, from March 2017 to September 2018. The study population comprised 42 cases diagnosed with thrombotic events during pregnancy and the postpartum period, including deep vein thrombosis (DVT), cortical venous thrombosis (CVT), and pulmonary thromboembolism (PTE). Using consecutive sampling from the hospital's labor register, 84 controls were selected, maintaining a case-to-control ratio of 1:2. Detailed clinical information was collected through direct patient interviews and medical record reviews. Body mass index (BMI) was calculated using pre-pregnancy weight and height measurements. Variables assessed included demographic characteristics, obstetric history, socioeconomic status, blood group, gestational age at thrombosis, type and location of thrombosis, risk factors, comorbidities, clinical manifestations, treatment modalities, and outcomes. Results The study demonstrated a significant association between obesity and thrombotic events in pregnancy and postpartum periods. In the case group, 21 patients (50.0%) presented with Class I obesity, and three patients (7.1%) with Class II obesity. The control group included 14 patients (16.7%) with Class I obesity and no patients (0%) with Class II obesity, revealing a significant difference in BMI class distribution between groups (χ2=25.979, p<0.001). Among the cases, DVT was the predominant presentation in 29 patients (69.0%), primarily affecting the ileo-femoral region in 26 patients (61.9%). CVT occurred in 12 patients (28.6%). Of the DVT patients, obesity was present in 17 patients (58.6%) compared to 12 non-obese patients (41.4%), showing statistical significance (χ²=14.488, p=0.001). Additional significant risk factors were identified in the study group: period of immobility affected five patients (11.9%), puerperal infection was present in five patients (11.9%), and antiphospholipid antibodies (APLA) positivity was found in five patients (11.9%). All these risk factors showed statistically significant differences compared to controls (p=0.001). Treatment outcomes were favorable, with 40 patients (95.2%) achieving either complete resolution or showing improvement. Conclusion Obesity significantly increases pregnancy-associated thrombosis risk, particularly DVT in the ileo-femoral region. Additional factors like immobility, puerperal infection, and APLA positivity contribute to thrombosis development. While treatment outcomes are favorable, early recognition and management are crucial, especially in women with multiple risk factors.

The Burden of Deep Vein Thrombosis and Risk Factors in Pregnancy and Postpartum-Mirroring Our Region's Particularities

(1) Background: The three factors within the Virchow triad play the leading role in the development of deep vein thrombosis (DVT) during pregnancy. (2) Methods: This research approaches the various risk factors associated with DVT and its most representative complications, pulmonary thromboembolism and cerebral venous thrombosis, in pregnant and postpartum women across a 15-year period (2007-2021). (3) Results: A total of 201 out of 287 patients with DVT had associated risk factors, while 86 did not present with any. Out of the 201 patients with risk factors, 47 developed pulmonary thromboembolism, while 12 experienced cerebral thrombosis. The statistical analysis of risk factors involved in DVT revealed high significance for obesity (OR 3.676; CI 2.484-5.439), gestational diabetes (OR 3.394; CI 2.101-5.483), hypertension (OR 2.325; CI 1.591-3.397), preeclampsia (OR 4.753; CI 2.342-9.645), thrombophilia (OR 12.138; CI 8.973-16.417), and varicose veins (OR 9.678; CI 7.321-12.793); for pulmonary thromboembolism, there was high significance for obesity (OR 7.867; CI 4.297-14.401), hypertension (OR 2.605; CI 1.246-5.446), preeclampsia (OR 7.483; CI 2.346-23.872), thrombophilia (OR 11.035; CI 5.910-20.602), and varicose veins (OR 6.837; CI 3.665-12.757); and for cerebral thromboembolism (CTE), the risk factors identified were obesity (OR 6.755; CI 1.954-23.347), hypertension (OR 1.167; CI 0.155-8.770), preeclampsia (OR 9.655; CI 1.283-72.672), and thrombophilia (OR 33.275; CI 12.884-85.939). (4) Conclusions: Obesity was the only significant factor found to influence DVT, pulmonary embolism and CTE risks, and hereditary thrombophilia was the main factor influencing the risk for pulmonary thromboembolism and CTE. Systemic lupus erythematosus and gestational diabetes revealed conflicting results that require further investigation.

Evaluating Thromboprophylaxis Strategies for High-Risk Pregnancy: A Current Perspective

Venous thromboembolism (VTE) represents one of the leading causes of death during pregnancy. The greatest risk for it is the presence of medical or family history of VTE, stillbirth, cesarean section and selected thrombophilia. Appropriate thromboprophylaxis has the potential to decrease the risk of VTE in at-risk pregnant patients by 60-70%. Based on this, the authors reviewed the PubMed, Web of Science and Scopus databases to identify the possibilities of thromboprophylaxis in pregnant patients with a high risk of VTE. Moreover, they summarized its management in specific situations, such as cesarean delivery or neuraxial blockade. Currently, low-molecular-weight heparins (LMWH) are the preferred drugs for anticoagulant thromboprophylaxis in the course of pregnancy and postpartum due to easy administration and a lower rate of adverse events.

Obesity, thrombosis, venous disease, lymphatic disease, and lipedema: An obesity medicine association (OMA) clinical practice statement (CPS) 2023

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians with an overview on obesity, thrombosis, venous disease, lymphatic disease, and lipedema.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

Topics in this CPS include obesity, thrombosis, venous disease, lymphatic disease, and lipedema. Obesity increases the risk of thrombosis and cardiovascular disease via fat mass and adiposopathic mechanisms. Treatment of thrombosis or thrombotic risk includes healthful nutrition, physical activity, and the requisite knowledge of how body weight affects anti-thrombotic medications. In addition to obesity-related thrombotic considerations of acute coronary syndrome and ischemic non-hemorrhagic stroke, this Clinical Practice Statement briefly reviews the diagnosis and management of clinically relevant presentations of deep vein thromboses, pulmonary embolism, chronic venous stasis, varicose veins, superficial thrombophlebitis, lipodermatosclerosis, corona phlebectatica, chronic thromboembolic pulmonary hypertension, iliofemoral venous obstruction, pelvic venous disorder, post-thrombotic syndrome, as well as lymphedema and lipedema - which should be included in the differential diagnosis of other edematous or enlargement disorders of the lower extremities.

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on obesity, thrombosis, and venous/lymphatic disease is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.