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

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

Epidemiology & Community Health

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Article number	100091
Journal	Research and Practice in Thrombosis and Haemostasis
Volume	7
Issue number	2
DOIs	https://doi.org/10.1016/j.rpth.2023.100091
State	Published - Feb 2023

Bibliographical note

Funding Information:
The manuscript was funded and supported by the National Institutes of Health National Heart Lung and Blood Institute grants R01 HL131579, K24 HL159246, and K24 HL148521. The supporters had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Data were obtained from MarketScan Commercial Claims and Encounters Databases. Data were de-identified and HIPAA compliant. The study was deemed exempt by the University of Minnesota Institutional Review Board. R.F.W. and P.L.L. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and Design: R.F.W. P.L.L. and N.A.Z conceptualized and designed the study. R.F.W. P.L.L. N.A.Z. S.M.M. and R.F.M acquired, analyzed, or interpreted the data. R.F.W. P.L.L. and N.A.Z drafted the manuscript. All authors critically revised the manuscript. R.F.W. performed the statistical analysis. P.L.L. and A.A. obtaining funding. There are no competing interests to disclose.

Funding Information:
The manuscript was funded and supported by the National Institutes of Health National Heart Lung and Blood Institute grants R01 HL131579, K24 HL159246, and K24 HL148521. The supporters had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2023 The Authors

Keywords

autoimmune diseases
postpartum period
pregnancy
systemic lupus erythematosus
venous thromboembolism

PubMed: MeSH publication types

Journal Article

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10.1016/j.rpth.2023.100091

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@article{f6ac33b7d45d4ac68b0e15a147903ea2,

title = "Autoimmune disease and risk of postpartum venous thromboembolism",

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",

author = "Walker, {Rob F.} and Zakai, {Neil A.} and Mason, {Susan M.} and MacLehose, {Richard F.} and Norby, {Faye L.} and Evensen, {Line H.} and Alvaro Alonso and Lutsey, {Pamela L.}",

note = "Funding Information: The manuscript was funded and supported by the National Institutes of Health National Heart Lung and Blood Institute grants R01 HL131579, K24 HL159246, and K24 HL148521. The supporters had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Data were obtained from MarketScan Commercial Claims and Encounters Databases. Data were de-identified and HIPAA compliant. The study was deemed exempt by the University of Minnesota Institutional Review Board. R.F.W. and P.L.L. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and Design: R.F.W. P.L.L. and N.A.Z conceptualized and designed the study. R.F.W. P.L.L. N.A.Z. S.M.M. and R.F.M acquired, analyzed, or interpreted the data. R.F.W. P.L.L. and N.A.Z drafted the manuscript. All authors critically revised the manuscript. R.F.W. performed the statistical analysis. P.L.L. and A.A. obtaining funding. There are no competing interests to disclose. Funding Information: The manuscript was funded and supported by the National Institutes of Health National Heart Lung and Blood Institute grants R01 HL131579, K24 HL159246, and K24 HL148521. The supporters had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = feb,

doi = "10.1016/j.rpth.2023.100091",

language = "English (US)",

volume = "7",

journal = "Research and Practice in Thrombosis and Haemostasis",

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T1 - Autoimmune disease and risk of postpartum venous thromboembolism

AU - Walker, Rob F.

AU - Zakai, Neil A.

AU - Mason, Susan M.

AU - MacLehose, Richard F.

AU - Norby, Faye L.

AU - Evensen, Line H.

AU - Alonso, Alvaro

AU - Lutsey, Pamela L.

N1 - Funding Information: The manuscript was funded and supported by the National Institutes of Health National Heart Lung and Blood Institute grants R01 HL131579, K24 HL159246, and K24 HL148521. The supporters had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Data were obtained from MarketScan Commercial Claims and Encounters Databases. Data were de-identified and HIPAA compliant. The study was deemed exempt by the University of Minnesota Institutional Review Board. R.F.W. and P.L.L. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and Design: R.F.W. P.L.L. and N.A.Z conceptualized and designed the study. R.F.W. P.L.L. N.A.Z. S.M.M. and R.F.M acquired, analyzed, or interpreted the data. R.F.W. P.L.L. and N.A.Z drafted the manuscript. All authors critically revised the manuscript. R.F.W. performed the statistical analysis. P.L.L. and A.A. obtaining funding. There are no competing interests to disclose. Funding Information: The manuscript was funded and supported by the National Institutes of Health National Heart Lung and Blood Institute grants R01 HL131579, K24 HL159246, and K24 HL148521. The supporters had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2023 The Authors

PY - 2023/2

Y1 - 2023/2

N2 - 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.

AB - 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.

KW - autoimmune diseases

KW - postpartum period

KW - pregnancy

KW - systemic lupus erythematosus

KW - venous thromboembolism

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ER -

Autoimmune disease and risk of postpartum venous thromboembolism

Abstract

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