Autoimmune disease and risk of postpartum venous thromboembolism.

• Type of Material: Article
• Authors: Rob F Walker, University of Minnesota, Minneapolis; Neil A Zakai, University of Vermont; Susan M Mason, University of Minnesota, Minneapolis; Richard F MacLehose, University of Minnesota, Minneapolis; Faye L Norby, edars-Sinai Health System; Line H Evensen, University of Norway; Alvaro Alonso, Emory University; Pamela L Lutsey, University of Minnesota, Minneapolis
• Language: English
• Date: 2023-02
• Publisher: Elsevier Inc
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.rpth.2023.100091
• Title of Journal or Parent Work: Res Pract Thromb Haemost
• Volume: 7
• Issue: 2
• Start Page: 100091
• End Page: 100091
• Grant/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.
• Keywords: systemic lupus erythematosus; postpartum period; autoimmune diseases; pregnancy; venous thromboembolism
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pathology

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.