产前、分娩期及产后静脉血栓栓塞的趋势

Trends in Antepartum, Delivery, and Postpartum Venous Thromboembolism.

作者信息

Kola Olivia, Huang Yongmei, D'Alton Mary E, Wright Jason D, Friedman Alexander M

机构信息

Rutgers New Jersey Medical School, Newark, New Jersey; the Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California.

出版信息

Obstet Gynecol. 2025 Mar 1;145(3):e98-e106. doi: 10.1097/AOG.0000000000005818. Epub 2025 Jan 2.

DOI:10.1097/AOG.0000000000005818

PMID:39746204

Abstract

OBJECTIVE

To assess trends in risk for obstetric venous thromboembolism (VTE).

METHODS

This retrospective cohort study analyzed data from the 2008-2019 Merative MarketScan Commercial Claims and Encounters and Medicaid Multi-State databases. Women aged 15-54 years with a delivery hospitalization and health care enrollment from 1 year before pregnancy to 60 days after delivery were identified. Risk for VTE during pregnancy from 2009 to 2019 was analyzed with joinpoint regression, with trends reported as the average annual percent change (APC). Venous thromboembolism events were identified with diagnosis codes along with pharmacy receipt of anticoagulants. Additionally, the association between risk factors for VTE and VTE events was evaluated with log-Poisson regression models with unadjusted and adjusted risk ratios (aRR) with 95% CIs as measures of association.

RESULTS

Among 1,970,971 pregnancies, there were 5,270 VTE events, of which 35.5% (n=1,871) included a pulmonary embolism diagnosis and 64.5% (3,399) included a deep vein thrombosis diagnosis, alone. Risk for VTE increased significantly during pregnancy over the study period, with an APC of 9.2% (95% CI, 5.7-12.9%). Rates of VTE also increased individually during the antenatal period (APC 8.2%, 95% CI, 3.7-12.9%), during delivery hospitalizations (APC 12.2%, 95% CI, 7.4-17.3%), during the postpartum period (APC 8.4%, 95% CI, 5.9-11.0%), and individually for vaginal and cesarean delivery hospitalizations. Trends analyses individually for pulmonary embolism (APC 12.4%, 95% CI, 8.6-16.4%) and deep vein thrombosis (APC 7.6%, 95% CI, 4.0-11.3%) also demonstrated significant increases. In adjusted analyses for VTE, obesity (aRR 1.91, 95% CI, 1.78-2.05), chronic heart disease (aRR 3.14, 95% CI, 2.93-3.37), tobacco use (aRR 1.61, 95% CI, 1.34-1.95), asthma (aRR 1.46, 95% CI, 1.33-1.60), and preeclampsia (aRR 1.44, 95% CI, 1.31-1.58) were the factors associated the greatest increased adjusted relative risk.

CONCLUSION

Risk for obstetric VTE increased significantly over the study period. Risk increased during the antenatal, delivery, and postpartum periods and for both cesarean and vaginal delivery.

摘要

目的

评估产科静脉血栓栓塞症（VTE）的风险趋势。

方法

这项回顾性队列研究分析了2008 - 2019年Merative MarketScan商业索赔与病历以及医疗补助多州数据库中的数据。确定了年龄在15 - 54岁之间、有分娩住院记录且在怀孕前1年至产后60天有医保登记的女性。采用连接点回归分析2009年至2019年怀孕期间VTE的风险，风险趋势以平均年变化百分比（APC）表示。通过诊断编码以及抗凝剂的药房配药记录来确定静脉血栓栓塞事件。此外，采用对数泊松回归模型评估VTE风险因素与VTE事件之间的关联，以未调整和调整后的风险比（aRR）及95%置信区间作为关联度量。

结果

在1,970,971例妊娠中，有5,270例VTE事件，其中35.5%（n = 1,871）包括肺栓塞诊断，64.5%（3,399）仅包括深静脉血栓形成诊断。在研究期间，怀孕期间VTE风险显著增加，APC为9.2%（95%置信区间，5.7 - 12.9%）。产前（APC 8.2%，95%置信区间，3.7 - 12.9%）、分娩住院期间（APC 12.2%，95%置信区间，7.4 - 17.3%）、产后期间（APC 8.4%，95%置信区间，5.9 - 11.0%）以及阴道分娩和剖宫产住院期间VTE发生率也分别增加。单独对肺栓塞（APC 12.4%，95%置信区间，8.6 - 16.4%）和深静脉血栓形成（APC 7.6%，95%置信区间，4.0 - 11.3%）进行的趋势分析也显示出显著增加。在VTE的调整分析中，肥胖（aRR 1.91，95%置信区间，1.78 - 2.05）、慢性心脏病（aRR 3.14，95%置信区间，2.93 - 3.37）、吸烟（aRR 1.61，95%置信区间，1.34 - 1.95）、哮喘（aRR 1.46，95%置信区间，1.33 - 1.60）和先兆子痫（aRR 1.44，95%置信区间，1.31 - 1.58）是与调整后相对风险增加最大相关的因素。