Type 1 Diabetes Mellitus and Thromboembolism in Pregnancy

Abstract

Objective

The impact of type 1 DM (T1DM) on thromboembolism in pregnancy is uncertain. We hypothesized that T1DM is associated with higher rates of thrombotic events during pregnancy and the postpartum period.

Study Design

This is a retrospective cohort study utilizing the National Inpatient Sample database from HCUP/AHRQ for 2017–2019. Pregnant and postpartum patients with a history of T1DM were compared to those without. The primary outcome was a composite diagnosis of any thrombotic disease (pulmonary embolism [PE], deep vein thrombosis [DVT], cerebral vascular thrombosis [CVT], or other thromboses). Secondary outcomes were the diagnosis of each individual type of thromboembolic event. Groups were compared via student's test, chi-squared, and logistic regression analyses, controlling for confounders including age, race, obesity, tobacco use, cHTN, asthma, anemia, and cesarean section.

Results

A total of 2,361,711 subjects met the criteria. Patients with T1DM encompassed 0.4% of subjects (n = 9,983). T1DM subjects were more likely to be younger, non-Hispanic white, obese, tobacco users, chronic hypertensive, asthmatic, and have a history of cesarean (all p < 0.001). They were less likely to be in the top income quartile. Thromboembolic events occurred more frequently in those with T1DM (0.45% vs. 0.20%, p < 0.001). DVT was the most common event (0.25%). After controlling for confounders, T1DM remained independently associated with any thromboembolic event in pregnancy (adjusted odds ratio [aOR] = 2.19, 95% confidence interval [CI]: 1.49–3.23), PE (aOR = 3.59, 95% CI: 1.65–7.82), and DVT (aOR = 2.43, 95% CI: 1.43–4.14).

Conclusion

T1DM is associated with an increased risk of thromboembolic events in pregnancy.

Key Points

• T1DM is independently associated with VTE.

• PE and DVT are the most common events.

• T1DM has an impact on VTE similar to obesity.

Keywords

Type 1 diabetes mellitus - VTE - thromboembolism - pregnancy

Publication History

Received: 03 June 2024

Accepted: 12 January 2025

Accepted Manuscript online:
14 January 2025

Article published online:
14 February 2025

• References

• 1 Vargas R, Repke JT, Ural SH. Type 1 diabetes mellitus and pregnancy. Rev Obstet Gynecol 2010; 3 (03) 92-100
• 2 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 201: pregestational diabetes mellitus. Obstet Gynecol 2018; 132 (06) e228-e248
• 3 Zöller B, Li X, Sundquist J, Sundquist K. Autoimmune diseases and venous thromboembolism: a review of the literature. Am J Cardiovasc Dis 2012; 2 (03) 171-183
• 4 Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton III LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143 (10) 697-706
• 5 Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Natality, on CDC WONDER Online Database. Data are from the Natality Records 2005–2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
• 6 Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359 (19) 2025-2033
• 7 Goodrich SM, Wood JE. Peripheral venous distensibility and velocity of venous blood flow during pregnancy or during oral contraceptive therapy. Am J Obstet Gynecol 1964; 90: 740-744
• 8 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 196: thromboembolism in pregnancy. Obstet Gynecol 2018; 132 (01) e1-e17
• 9 Committee on Practice Bulletins—Obstetrics, American College of Obstetricians and Gynecologists. Practice bulletin no. 132: antiphospholipid syndrome. Obstet Gynecol 2012; 120 (06) 1514-1521
• 10 HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2017–2019. Agency for Healthcare Research and Quality, Rockville, MD
• 11 Tawfik DS, Gould JB, Profit J. Perinatal risk factors and outcome coding in clinical and administrative databases. Pediatrics 2019; 143 (02) e20181487
• 12 Peng YH, Lin YS, Chen CH. et al. Type 1 diabetes is associated with an increased risk of venous thromboembolism: a retrospective population-based cohort study. PLoS One 2020; 15 (01) e0226997
• 13 Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008; 117 (01) 93-102
• 14 Hinton W, Nemeth B, de Lusignan S. et al. Effect of type 1 diabetes and type 2 diabetes on the risk of venous thromboembolism. Diabet Med 2021; 38 (05) e14452
• 15 Sultan AA, Tata LJ, West J. et al. Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom. Blood 2013; 121 (19) 3953-3961
• 16 Lüscher TF, Creager MA, Beckman JA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II. Circulation 2003; 108 (13) 1655-1661
• 17 Lemkes BA, Hermanides J, Devries JH, Holleman F, Meijers JC, Hoekstra JB. Hyperglycemia: a prothrombotic factor?. J Thromb Haemost 2010; 8 (08) 1663-1669
• 18 Grant PJ. Diabetes mellitus as a prothrombotic condition. J Intern Med 2007; 262 (02) 157-172
• 19 McLintock C, Brighton T, Chunilal S. et al. Councils of the Society of Obstetric Medicine of Australia and New Zealand, Australasian Society of Thrombosis and Haemostasis. Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Aust N Z J Obstet Gynaecol 2012; 52 (01) 14-22
• 20 Urato AC, Abi-Jaoude E, Abramson J. et al. National Partnership for Maternal Safety: consensus bundle on venous thromboembolism. Obstet Gynecol 2019; 134 (05) 1115-1117
• 21 Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based clinical practice guidelines. Chest 2012; 141 (02) e691S-e736S
• 22 Bates SM, Middeldorp S, Rodger M, James AH, Greer I. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism. J Thromb Thrombolysis 2016; 41 (01) 92-128
• 23 Royal College of Obstetricians and Gynaecologists. Reducing the risk of venous thromboembolism during pregnancy and the puerperium. Green Top Guideline No. 37a. London (UK): RCOG; 2015
• 24 Liu S, Rouleau J, Joseph KS. et al. Epidemiology of pregnancy-associated venous thromboembolism: a population-based study in Canada. J Obstet Gynaecol Can 2009; 31 (07) 611-620