Developing a model for predicting venous thromboembolism in obese pregnant women in a national study

Document Type

Journal Article

Publication Date

7-1-2020

Journal

Thrombosis Research

Volume

191

DOI

10.1016/j.thromres.2020.03.025

Keywords

Low molecular weight heparin; Maternal morbidity; Obesity; Pregnancy; Thromboprophylaxis; Venous thromboembolism

Abstract

© 2020 Elsevier Ltd Introduction: Venous thromboembolism (VTE) in pregnancy and postpartum is a leading cause of maternal morbidity and mortality in developed countries, where obesity is a known risk for this complication. Current guidelines vary in which patients qualify for VTE prophylaxis, precluding a uniform approach for management. We sought to derive a risk prediction model for VTE in obese pregnant women. Materials and methods: We performed a retrospective cohort analysis using the Consortium on Safe Labor (CSL) database. Women ages 16–45 who were pregnant with singletons and had an obese body mass index (>30 kg/m2) were included in our study population. Multivariable logistic regression was used in order to identify predictors of venous thromboembolism. Results: Of the 83,500 women who met inclusion criteria, on average women were 27.8 years old, 38.6 weeks gestation, with body mass index of 35.8, and cesarean delivery incidence of 35.2%. 109 women (0.13%) experienced a VTE event. Independent predictors of VTE in our final multivariable predictive model included: mode of delivery, body mass index, pregestational diabetes, chronic heart disease, preeclampsia, blood transfusion (intrapartum or postpartum), prenatal history of thromboembolic disorder, and postpartum maternal length of stay. A receiver operating characteristic curve was developed to assess the model; area under the curve was 0.826. Conclusions: We developed a strong predictive model using a large, retrospective database to distinguish risk of VTE in obese pregnant women, which may provide the foundation for future protocol development of obstetrical thromboprophylaxis in obese women.

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