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#Grand Rounds

What impact does Pre-pregnancy BMI have on Venous Thromboembolism Risk?

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BACKGROUND AND PURPOSE:

  • Obesity is a well-known risk factor for venous thromboembolism (VTE)
  • Butwick et al. (BJOG 2018) assessed the relationship between pre-pregnancy BMI and pregnancy-related VTE

METHODS:

  • Population-based cohort study
    • Women age 15 to 50 years
    • Singleton pregnancies
    • Delivered in any California hospital (2008 – 2012)
  • Primary exposure: Pre-pregnancy BMI
    • Categorized using WHO classification (see ‘Related ObG Topics’ below)
  • Determined pre-pregnancy BMI and presence of
    • Antepartum VTE | Postpartum (up to 9 months) VTE (delivery VTE also assessed, but due to low ‘n’, multivariate analysis could not be performed)
  • Association of BMI and risk of VTE was examined using logistic regression, with normal BMI as reference

RESULTS:

  • 2,449,133 women were included
  • Overall prevalence of VTE
    • Antepartum: 0.04%
    • Delivery: 0.01%
    • Postpartum: 0.04%

Prevalence of antepartum and postpartum VTE increased with higher BMI

  • Antepartum VTE (P < 0.001)
    • Underweight: 2.3/10,000
    • Normal BMI: 3.0/10,000
    • Overweight: 3.8/10,000
    • Obesity class I: 4.2/10,000
    • Obesity class II: 4.7/10,000
    • Obesity class III: 10.6/10,000
  • Postpartum VTE (P < 0.01)
    • Underweight: 2.0/10,000
    • Normal BMI: 3.1/10,000
    • Overweight: 3.9/10,000
    • Obesity class I: 5.6/10,000
    • Obesity class II: 9.0/10,000
    • Obesity class III: 13.2/10,000
  • Obesity class III women had highest risk of pregnancy-related VTE compared to normal BMI women
    • Antepartum VTE:  Adjusted odds ratio (OR) 2.9 (95% CI, 2.2–3.8)
    • Postpartum VTE:  aOR 3.6; (95% CI 2.9–4.6)

CONCLUSION:

  • Strong ‘dose response’ effects between pre-pregnancy BMI with antepartum and postpartum VTE
  • Obesity class III should be considered a ‘major risk factor’ for antepartum and postpartum VTE and may inform future guideline considerations

Learn more – Primary Sources:

Prepregnancy maternal body mass index and venous thromboembolism: a population-based cohort study

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Related ObG Topics:

Does BMI Impact Success of Vacuum-Assisted Vaginal Delivery?
Practical obstetrics info for your women's healthcare practice
Recommended Weight Gain and Obesity Management in Pregnancy
ACOG Guidance on Thrombophilia in Pregnancy
The CMQCC Toolkit: Venous Thromboembolism Prevention and Management at Delivery

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