Autoimmune disease and risk of postpartum venous thromboembolism

Rob F Walker; Neil A Zakai; Susan M Mason; Richard F MacLehose; Faye L Norby; Line H Evensen; Alvaro Alonso; Pamela L Lutsey

doi:10.1016/j.rpth.2023.100091

Autoimmune disease and risk of postpartum venous thromboembolism

Res Pract Thromb Haemost. 2023 Feb 23;7(2):100091. doi: 10.1016/j.rpth.2023.100091. eCollection 2023 Feb.

Authors

Rob F Walker¹, Neil A Zakai^{2

3}, Susan M Mason¹, Richard F MacLehose¹, Faye L Norby⁴, Line H Evensen⁵, Alvaro Alonso⁶, Pamela L Lutsey¹

Affiliations

¹ School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
² Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
³ Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
⁴ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California, USA.
⁵ K.G. Jebsen - Thrombosis Research and Expertise Center, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.
⁶ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

Abstract

Background: The risk of pregnancy-related mortality in the United States has nearly doubled since 1990, with venous thromboembolism (VTE) accounting for approximately 10% of these deaths.

Objectives: The objective of this study was to assess whether preexisting autoimmune disease is a risk factor for postpartum VTE.

Methods: Using the MarketScan Commercial and Medicare Supplemental administrative databases, a retrospective cohort study analyzed whether postpartum persons with autoimmune disease had a higher risk of postpartum VTE incidence than postpartum persons without autoimmune disease. Using International Classification of Diseases codes, we identified 757,303 individuals of childbearing age who had a valid delivery date with at least 12 weeks of follow-up.

Results: Individuals were, on average, 30.7 years old (SD, 5.4), and 3.7% (N = 27,997 of 757,303) of them had evidence of preexisting autoimmune disease. In covariate-adjusted models, postpartum persons with preexisting autoimmune disease had higher rates of postpartum VTE than postpartum persons without autoimmune disease (hazard ratio [HR], 1.33; 95% CI, 1.07-1.64). When analyzed by individual autoimmune disease, those with systemic lupus erythematosus (HR, 2.49; 95% CI, 1.47-4.21) and Crohn's disease (HR, 2.49; 95% CI, 1.34-4.64) were at an elevated risk of postpartum VTE compared with those without autoimmune disease.

Conclusion: Autoimmune disease was associated with a higher rate of postpartum VTE, with evidence that the association was most pronounced among individuals with systemic lupus erythematosus and Crohn's disease. These findings suggest that postpartum persons of childbearing age with autoimmune disease may require more monitoring and prophylactic care after delivery to prevent potentially fatal VTE events.

Keywords: autoimmune diseases; postpartum period; pregnancy; systemic lupus erythematosus; venous thromboembolism.

Abstract

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