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Endometriosis and Recurrent Pregnancy Loss as New Risk Factors for Venous Thromboembolism during Pregnancy and Post-Partum: The JECS Birth CohortFunding This study was funded by the Ministry of the Environment, Government of Japan.
11 October 2018
17 December 2018
05 February 2019 (online)
Background Since venous thromboembolism (VTE) is one of the causes of maternal mortality, several guidelines recommend prophylaxis using low molecular weight heparin for women in high-risk groups. The number of large population-based studies examining predictors for VTE has been limited, and there has been no study based on a Japanese population.
Objective Our objective was to examine VTE risk factor during the pregnancy and post-partum period.
Materials and Methods A nationwide birth cohort study known as the ‘Japan Environment and Children's Study (JECS)’ was conducted by the Ministry of the Environment. The subjects consisted of 103,070 pregnancies recruited by the JECS between January 2011 and March 2014. Pregnant women completed the questionnaires during the first and second/third trimester. Their medical records were transcribed by physicians or research coordinators at registration, just after delivery and at 1 month after delivery.
Results The frequency of VTE was 7.5 per 10,000 pregnancies (77 of 103,070) during the pregnancy and post-partum period. After the adjustment of multiple covariates for each factor, endometriosis and recurrent pregnancy loss (RPL) were identified as novel independent risk factors for VTE. Adjusted odds ratios were as follows: 2.70 (95% confidence interval, 1.21–6.00) for endometriosis and 6.13 (2.48–15.16) for RPL. Threatened abortion, threatened pre-term birth, pre-term birth and caesarean section were ascertained to be risk factors for VTE.
Conclusion Careful attention should be given to novel predictors, such as endometriosis and a history of RPL, to prevent VTE during the pregnancy and post-partum period.
Keywordsvenous thromboembolism - birth cohort study - pregnancy - post-partum - recurrent pregnancy loss
The JECS group conducted the nationwide study project. M.S.O. designed the present study, analysed the data and wrote the first draft of the manuscript. T.E. organized the study team and was responsible for obtaining and analysing the data. M.K., a member of the JECS Steering Committee, was responsible for data acquisition and supervision of the study. M.K. and T.O. took the initiative in the launch of the Aichi regional sub-cohort of JECS. T.M. analysed the data. Y.Y., T.O., Y.M., S.K. and S.S. were responsible for data acquisition. All authors interpreted the data, contributed to the writing of the manuscript and revised it critically for important intellectual content.
Data sharing is not permitted by the JECS due to a government policy restricting the deposition of data containing personal information. See the reference for more details.
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