Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
JAMA Netw Open. 2023 Nov 1;6(11):e2343804. doi: 10.1001/jamanetworkopen.2023.43804.
As venous thromboembolism (VTE) remains one of the leading causes of maternal mortality, identifying women at increased risk of VTE is of great importance. Preeclampsia is a pregnancy-induced hypertensive disorder with generalized endothelial dysfunction. Some studies suggest that preeclampsia is associated with an increased risk of VTE, but much controversy exists.
To examine the association between preeclampsia and the risk of VTE during pregnancy, during the puerperium, and after the puerperium.
DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study used Danish nationwide registries to identify all eligible primiparous women who gave birth in Denmark from January 1, 1997, to December 31, 2016. The women were followed up from primiparous pregnancy to incident VTE, emigration, death, or the end of the study (December 31, 2016). Statistical analyses were carried out from January to May 2023.
Preeclampsia during primiparous pregnancy.
The main outcome was incident VTE, and the secondary outcome was all-cause mortality.
A total of 522 545 primiparous women (median age, 28 years [IQR, 25-31 years]) were included, and 23 330 (4.5%) received a diagnosis of preeclampsia. Women with preeclampsia were of similar age to women without preeclampsia but had a higher burden of comorbidities. During a median follow-up of 10.2 years (IQR, 5.2-15.4 years), preeclampsia was associated with a higher incidence of VTE compared with no preeclampsia (incidence rate, 448.8 [95% CI, 399.9-503.5] vs 309.6 [95% CI, 300.6-319.9] per 1000 patient-years, corresponding to an unadjusted hazard ratio [HR] of 1.45 [95% CI, 1.29-1.63] and an adjusted HR of 1.43 [95% CI, 1.27-1.61]). When stratified according to the subcategories of VTE, preeclampsia was associated with an increased rate of deep vein thrombosis (unadjusted HR, 1.51 [95% CI, 1.32-1.72] and adjusted HR, 1.49 [95% CI, 1.31-1.70]) as well as pulmonary embolism (unadjusted HR, 1.39 [95% CI, 1.09-1.76]; adjusted HR, 1.36 [95% CI, 1.08-1.73]). These findings held true in landmark analyses during pregnancy, during the puerperium, and after the puerperium.
This cohort study suggests that preeclampsia was associated with a significantly increased risk of VTE during pregnancy, during the puerperium, and after the puerperium, even after thorough adjustment. Future studies should address how to improve the clinical management of women with a history of preeclampsia to prevent VTE.
静脉血栓栓塞症（VTE）仍然是导致孕产妇死亡的主要原因之一，因此识别出具有 VTE 风险增加的女性非常重要。子痫前期是一种与全身内皮功能障碍相关的妊娠高血压疾病。一些研究表明，子痫前期与 VTE 风险增加有关，但存在很大争议。
研究子痫前期与妊娠、产褥期和产褥期后 VTE 风险之间的关系。
设计、地点和参与者：这项观察性队列研究使用丹麦全国性登记处，确定了 1997 年 1 月 1 日至 2016 年 12 月 31 日期间在丹麦分娩的所有符合条件的初产妇。这些女性从初产妇妊娠开始随访至发生 VTE、移民、死亡或研究结束（2016 年 12 月 31 日）。统计分析于 2023 年 1 月至 5 月进行。
初产妇妊娠期间的子痫前期。
主要结局是发生 VTE，次要结局是全因死亡率。
共纳入 522545 名初产妇（中位年龄 28 岁[IQR，25-31 岁]），其中 23330 名（4.5%）诊断为子痫前期。患有子痫前期的女性与没有子痫前期的女性年龄相仿，但合并症负担更高。在中位随访 10.2 年（IQR，5.2-15.4 年）期间，与没有子痫前期相比，子痫前期与 VTE 发生率较高相关（发病率，448.8[95%CI，399.9-503.5]vs 309.6[95%CI，300.6-319.9]每 1000 名患者年，相应的未调整危险比[HR]为 1.45[95%CI，1.29-1.63]和调整后的 HR 为 1.43[95%CI，1.27-1.61]）。根据 VTE 的亚分类进行分层时，子痫前期与深静脉血栓形成（未调整 HR，1.51[95%CI，1.32-1.72]和调整 HR，1.49[95%CI，1.31-1.70]）和肺栓塞（未调整 HR，1.39[95%CI，1.09-1.76]；调整 HR，1.36[95%CI，1.08-1.73]）的发生率增加相关。这些发现在妊娠、产褥期和产褥期后进行的里程碑式分析中成立。
这项队列研究表明，即使经过彻底调整，子痫前期与妊娠、产褥期和产褥期后 VTE 风险显著增加相关。未来的研究应探讨如何改善有子痫前期病史的女性的临床管理，以预防 VTE。
