Browse > Article
http://dx.doi.org/10.4070/kcj.2011.41.1.23

Pregnancy-Induced Hypertension, But Not Gestational Diabetes Mellitus, Is a Risk Factor for Venous Thromboembolism in Pregnancy  

Won, Hyun-Sun (Division of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine)
Kim, Do-Yi (Division of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine)
Yang, Moon-Seok (Division of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine)
Lee, Sung-Ja (Division of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine)
Shin, Hyun-Ho (Division of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine)
Park, Jeong-Bae (Division of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine)
Publication Information
Korean Circulation Journal / v.41, no.1, 2011 , pp. 23-27 More about this Journal
Abstract
Background and Objectives: The aim of this study was to identify the association of pregnancy-induced hypertension (PIH) or gestational diabetes mellitus (GDM) with the development of venous thromboembolism (VTE). Subjects and Methods: This was a retrospective study of 57,009 pregnancies during 2002-2008 at Cheil General Hospital, Kwandong University. The diagnosis of VTE {deep vein thrombosis or pulmonary embolism (PE)} was based on clot visualization via ultrasound or computed tomography. Results: In total, 27 cases (PE, 20 cases) were detected. The incidence of VTE was 0.47 per 1,000 pregnancies. To determine risk factors associated with pregnancy-induced VTE, univariate analysis using a chi-square test was performed. Cesarean (C)-section, multiple pregnancy, PIH, placenta previa, and assisted reproduction technique (ART) were statistically significant compared to the controls (all, p=0.000). However, age, premature rupture of membrane, and GDM were not statistically related to VTE. Logistic regression analysis was used to calculate the odds ratios for the risk factors. Placenta previa showed a 12.6-fold higher risk, while PIH had a 9.8-fold higher risk for the occurrence of VTE. C-section and ART procedures increased the risk of VTE by 4.2 times compared to that of the controls. Conclusion: Placenta previa and PIH were significant risk factors for VTE, whereas the known traditional risk factors of increased age and GDM were not found to be associated with VTE.
Keywords
Venous thromboembolism; Pregnancy-induced hypertension; Gestational diabetes;
Citations & Related Records

Times Cited By SCOPUS : 0
연도 인용수 순위
  • Reference
1 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.e1-7.
2 Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008;359:2025-33.   DOI   ScienceOn
3 Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999;353:1258-65.   DOI   ScienceOn
4 Moon HJ, Rhim CY, Kim GW, et al. Risk factors of deep vein thrombo-sis and pulmonary embolism in Korean. Korean Circ J 2005;35:474-9.
5 Kim KY, Moon KW, Jeon DS, et al. A case of hereditary antithrombin III defiency manifestation of infarct and deep vein thrombosis. Korean Circ J 2002;32:521-5.   DOI
6 Lee SW, Seo HS, Ghil JH, Rim SJ, Kang SM, Chung NS. A case of in-ternal Jugular vein thrombosis after in vitro fertilization. Korean Circ J 2004;34:214-9.   DOI
7 Lindqvist P, Dahlback B, Marsal K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol 1999;94:595-9   DOI
8 Ros HS, Lichtenstein P, Bellocco R, Petersson G, Cnattingius S. Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified? Am J Obstet Gynecol 2002;186:198-203.   DOI   ScienceOn
9 Report of the National High Blood Pressure Education Program Work-ing group report on high blood pressure in pregnancy. Am J Obstet Gy-necol 2000;183:S1-22.
10 Cheung NW, Byth K. The population health significance of gestational diabetes. Diabetes Care 2003;26:2005-9.   DOI   ScienceOn
11 James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol 2006;194:1311-5.   DOI   ScienceOn
12 Heit JA, Leibson CL, Ashrani AA, Petterson TM, Bailey KR, Melton LJ 3rd. Is diabetes mellitus an independent risk factor for venous th-romboembolism? Arterioscler Thromb Vasc Biol 2009;29:1399-405.   DOI   ScienceOn
13 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768-73.
14 Koonin LM, MacKay AP, Berg CJ, Atrash HK, Smith JC. Pregnancy-induced mortality surveillance: United States, 1987-1990. MMWR CDC Surveill Summ 1997;46:17-36.
15 Brill-Edwards P, Ginsberg JS, Gent M, et al. Safety of withholding heparin in pregnant women with a history of venous thromboembolism. N Engl J Med 2000;343:1439-44.   DOI   ScienceOn
16 Pabinger I, Grafenhofer H, Kaider A, et al. Risk of pregnancy-associated recurrent venous thromboembolism in women with a history of venous thrombosis. J Thromb Haemost 2005;3:949-54.   DOI   ScienceOn
17 Kestenbaum B, Seliger SL, Easterling TR, et al. Cardiovascular and thromboembolic events following hypertensive pregnancy. Am J Kidney Dis 2003;42:982-9.   DOI   ScienceOn
18 Royal College of Obstetricians and Gynaecologists (RCOG). Thromboprophylaxis during pregnancy, labour and after vaginal delivery. Guideline No. 37. London: RCOG Press;2004.
19 Royal College of Obstetricians and Gynaecologists (RCOG). Report of the Royal College of Obstetricians and Gynaecologists (RCOG) working party on prophylaxis against thromboembolism in gynaecology and obstetrics. London: RCOG Press;1995.
20 Gherman RB, Goodwin TM, Leung B, Byrne JD, Hethumumi R, Mon-toro M. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999;94:730-4.   DOI   ScienceOn
21 Roberts RN, Henriksen JE, Hadden DR. Insulin sensitivity in pre-eclampsia. Br J Obstet Gynaecol 1998;105:1095-100.   DOI
22 Morris NH, Eaton BM, Dekker G. Nitric oxide, the endothelium, pregnancy and pre-eclampsia. Br J Obstet Gynaecol 1996;103:4-15.   DOI
23 Tsai AW, Cushman M, Rosamond WD, Heckbert SR, Polak JF, Folsom AR. Cardiovascular risk factors and venous thromboembolism incidence. Arch Intern Med 2002;162:1182-9.   DOI   ScienceOn
24 Petrauskiene V, Falk M, Waernbaum I, Norberg M, Eriksson JW. The risk of venous thromboembolism is markedly elevated in patients with diabetes. Diabetologia 2005;48:1017-21.   DOI   ScienceOn
25 Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008;117:93-102.   DOI   ScienceOn
26 James AH. Thromboembolism in pregnancy: recurrence risks, prevention and management. Curr Opin Obstet Gynecol 2008;20:550-6.   DOI   ScienceOn
27 Santoro R, Iannaccaro P, Prejanò S, Muleo G. Efficacy and safety of the long-term administration of low-molecular-weight heparins in pregn-ancy. Blood Coagul Fibrinolysis 2009;20:240-3.   DOI   ScienceOn
28 Spyropoulos AC, Turpie AG, Dunn AS, et al. Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as bridging therapy in patients on long-term oral anticoagulants: the REGIMEN registry. J Thromb Haemost 2006;4:1246-52.   DOI   ScienceOn