Associations of blood pressure in the third trimester and risk of venous thromboembolism postpartum

Qian Li1,2, Hongfei Wang3, Huafang Wang1,2, Jun Deng1,2, Zhipeng Cheng1,2, Fengjuan Fan1,2, Wenyi Lin1,2, Ruiqi Zhu1,2, Shi Chen4, Jinrong Guo5, Yuxiong Weng6, Liang V. Tang1,2(), Yu Hu1,2()

PDF
MedComm ›› 2024, Vol. 5 ›› Issue (7) : e619. DOI: 10.1002/mco2.619
ORIGINAL ARTICLE

Associations of blood pressure in the third trimester and risk of venous thromboembolism postpartum

  • Qian Li1,2, Hongfei Wang3, Huafang Wang1,2, Jun Deng1,2, Zhipeng Cheng1,2, Fengjuan Fan1,2, Wenyi Lin1,2, Ruiqi Zhu1,2, Shi Chen4, Jinrong Guo5, Yuxiong Weng6, Liang V. Tang1,2(), Yu Hu1,2()
Author information +
History +

Abstract

Studies on the associations of blood pressure (BP) and the risk of venous thromboembolism (VTE) had been performed neither among pregnant women nor in Chinese population. This study included participants of pregnant women from a retrospective multicenter cohort, between May 2020 and April 2023. Systolic BP (SBP) and diastolic BP (DBP) of the participants were measured in the third trimester. The incidences of VTE (including deep venous thrombosis and/or pulmonary embolism) at 42 days postpartum were followed. With regards to SBP, pregnant women in the Q1 (≤114 mmHg), Q2 (115–122 mmHg), and Q4 group (≥131 mmHg) had increased risk of VTE than those in Q3 group (123–130 mmHg), with ORs 4.48 [1.69, 11.85], 3.52 [1.30, 9.59], and 3.17 [1.12, 8.99], respectively. Compared with pregnant women with the Q4 of DBP (≥85 mmHg), women of Q1 (≤71 mmHg) were found to have elevated risk of VTE (OR 2.73 [1.25, 5.96]). A one standard deviation decrease of DBP (9 mmHg) was related with 37% elevated risk of VTE (OR 1.37 [1.05, 1.79]). This study demonstrated a U-shaped association of SBP in the third trimester and VTE postpartum and inverse association of DBP in the third trimester and VTE postpartum.

Keywords

diastolic blood pressure / postpartum / pregnant women / systolic blood pressure / venous thromboembolism

Cite this article

Download citation ▾
Qian Li, Hongfei Wang, Huafang Wang, Jun Deng, Zhipeng Cheng, Fengjuan Fan, Wenyi Lin, Ruiqi Zhu, Shi Chen, Jinrong Guo, Yuxiong Weng, Liang V. Tang, Yu Hu. Associations of blood pressure in the third trimester and risk of venous thromboembolism postpartum. MedComm, 2024, 5(7): e619 https://doi.org/10.1002/mco2.619

References

1 MJ Jang, SM Bang, D Oh. Incidence of pregnancy-associated venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost. 2011;9(12):2519-2521.
2 JA Heit, CE Kobbervig, AH James, TM Petterson, KR Bailey. 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. 3rd.
3 E Samuelsson, K Hedenmalm, I Persson. Mortality from venous thromboembolism in young Swedish women and its relation to pregnancy and use of oral contraceptives—an approach to specifying rates. Eur J Epidemiol. 2005;20(6):509-516.
4 AM Aukes, K Arion, JN Bone, et al. Causes and circumstances of maternal death: a secondary analysis of the community-level interventions for pre-eclampsia (CLIP) trials cohort. Lancet Glob Health. 2021;9(9):e1242-e1251.
5 K Ewins, F Ni Ainle. VTE risk assessment in pregnancy. Res Pract Thromb Haemost. 2020;4(2):183-192.
6 AF Jacobsen, FE Skjeldestad, PM Sandset. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium—a register-based case-control study. Am J Obstet Gynecol. 2008;198(2):233. e1-7.
7 K Egan, B Kevane, F Ni Ainle. Elevated venous thromboembolism risk in preeclampsia: molecular mechanisms and clinical impact. Biochem Soc Trans. 2015;43(4):696-701.
8 Q Li, H Wang, H Wang, et al. Association between serum alkaline phosphatase levels in late pregnancy and the incidence of venous thromboembolism postpartum: a retrospective cohort study. EClinicalMedicine. 2023;62:102088.
9 SJ Willis, A Peyrard, T Rupp, F Borrani, GP Millet. Vascular and oxygenation responses of local ischemia and systemic hypoxia during arm cycling repeated sprints. J Sci Med Sport. 2019;22(10):1151-1156.
10 JS Pober, WC Sessa. Evolving functions of endothelial cells in inflammation. Nat Rev Immunol. 2007;7(10):803-815.
11 V Turi, S Dragan, M Iurciuc, et al. Arterial function in healthy pregnant women vs. non-pregnant women—a 10-year study. Diagnostics. 2020;10(6):374.
12 P Muntner, D Shimbo, RM Carey, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension. 2019;73(5):e35-e66.
13 G Grindheim, ME Estensen, E Langesaeter, LA Rosseland, K Toska. Changes in blood pressure during healthy pregnancy: a longitudinal cohort study. J Hypertens. 2012;30(2):342-350.
14 V Nama, TF Antonios, J Onwude, IT Manyonda. Mid-trimester blood pressure drop in normal pregnancy: myth or reality? J Hypertens. 2011;29(4):763-768.
15 E Kovanci, AR Gregg. Blood pressure regulation across pregnancy: evidence of a paradigm shift in gene expression. Hypertens Pregnancy. 2010;29(2):236-247.
16 AC Bischops, JW De Neve, A Awasthi, S Vollmer, T B?rnighausen, P Geldsetzer. A cross-sectional study of cardiovascular disease risk clustering at different socio-geographic levels in India. Nat Commun. 2020;11(1):5891.
17 J Zhao, Y Yu, X Zhu, et al. Predicting risk on cardiovascular or cerebrovascular disease based on a physical activity cohort: results from APAC study. MedComm. 2023;4:e220.
18 BK Mahmoodi, M Cushman, I Anne Naess, et al. Association of traditional cardiovascular risk factors with venous thromboembolism: an individual participant data meta-analysis of prospective studies. Circulation. 2017;135(1):7-16.
19 M Nazarzadeh, Z Bidel, H Mohseni, et al. Blood pressure and risk of venous thromboembolism: a cohort analysis of 5.5 million UK adults and Mendelian randomization studies. Cardiovasc Res. 2023;119(3):835-842.
20 H Wang, FR Rosendaal, M Cushman, A van Hylckama Vlieg. Association between cardiovascular risk factors and venous thromboembolism in the elderly. Res Pract Thromb Haemost. 2022;6(2):e12671.
21 Y Tsubata, T Hotta, K Hamai, et al. A new risk-assessment tool for venous thromboembolism in advanced lung cancer: a prospective, observational study. J Hematol Oncol. 2022;15(1):40.
22 AG Holst, G Jensen, E Prescott. Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation. 2010;121(17):1896-1903.
23 J Gregson, S Kaptoge, T Bolton, et al. Cardiovascular risk factors associated with venous thromboembolism. JAMA Cardiol. 2019;4(2):163-173.
24 Y Lee, Q Jehangir, P Li, et al. Venous thromboembolism in COVID-19 patients and prediction model: a multicenter cohort study. BMC Infect Dis. 2022;22(1):462.
25 P Quist-Paulsen, IA Naess, SC Cannegieter, et al. Arterial cardiovascular risk factors and venous thrombosis: results from a population-based, prospective study (the HUNT 2). Haematologica. 2010;95(1):119-125.
26 M Hu, X Li, Y Yang. Causal associations between cardiovascular risk factors and venous thromboembolism. Semin Thromb Hemost. 2023;49(7):679-687.
27 PO Hansson, H Eriksson, L Welin, K Sv?rdsudd, L Wilhelmsen. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: ‘’the study of men born in 1913″. Arch Intern Med. 1999;159(16):1886-1890.
28 K Wattanakit, PL Lutsey, EJ Bell, et al. Association between cardiovascular disease risk factors and occurrence of venous thromboembolism. A time-dependent analysis. Thromb Haemost. 2012;108(3):508-515.
29 AW Tsai, M Cushman, WD Rosamond, SR Heckbert, JF Polak, AR Folsom. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med. 2002;162(10):1182-1189.
30 M Umesawa, G Kobashi. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res. 2017;40(3):213-220.
31 Q Li, S Xu, X Chen, et al. Folic acid supplement use and increased risk of gestational hypertension. Hypertension. 2020;76(1):150-156.
32 R Gaillard, R Bakker, SP Willemsen, A Hofman, EA Steegers, VW Jaddoe. Blood pressure tracking during pregnancy and the risk of gestational hypertensive disorders: the Generation R Study. Eur Heart J. 2011;32(24):3088-3097.
33 A Hauspurg, S Parry, BM Mercer, et al. Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women. Am J Obstet Gynecol. 2019;221(3):277. e1-e8.
34 J Hu, Y Li, B Zhang, et al. Impact of the 2017 ACC/AHA guideline for high blood pressure on evaluating gestational hypertension-associated risks for newborns and mothers. Circ Res. 2019;125(2):184-194.
35 FA Wilmink, HT den Dekker, JC de Jongste, et al. Maternal blood pressure and hypertensive disorders during pregnancy and childhood respiratory morbidity: the Generation R Study. Eur Respir J. 2018;52(5):1800378.
36 H Valensise, GP Novelli, B Vasapollo, et al. Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and echocardiographic longitudinal study. Ultrasound Obstet Gynecol. 2000;15(6):487-497.
37 D Curran-Everett, KG Morris, LG Moore. Regional circulatory contributions to increased systemic vascular conductance of pregnancy. Am J Physiol. 1991;261(6):H1842-H1847. Pt 2.
38 Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-e260.
39 Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):s1-s22.
40 PA James, S Oparil, BL Carter, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.
41 BR Line. Pathophysiology and diagnosis of deep venous thrombosis. Semin Nucl Med. 2001;31(2):90-101.
42 W Ageno, C Becattini, T Brighton, R Selby, PW Kamphuisen. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation. 2008;117(1):93-102.
43 SZ Goldhaber, F Grodstein, MJ Stampfer, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997;277(8):642-645.
44 P Prandoni, F Bilora, A Marchiori, et al. An association between atherosclerosis and venous thrombosis. N Engl J Med. 2003;348(15):1435-1441.
45 TA Morris. Natural history of venous thromboembolism. Crit Care Clin. 2011;27(4):869-884. vi.
46 ZY Zhang, C Carmeli, B Ponte, et al. Ambulatory blood pressure in relation to plasma and urinary manganese. Hypertension. 2020;75(4):1133-1139.
47 W Krzy?ciak, M Kózka, J Kowalska, WM Kwiatek. Role of Zn, Cu—trace elements and superoxide dismutase (SOD) in oxidative stress progression in chronic venous insufficiency (CVI). Przegl Lek. 2010;67(7):446-449.
48 A Gerhardt, RE Scharf, IA Greer, RB Zotz. Hereditary risk factors for thrombophilia and probability of venous thromboembolism during pregnancy and the puerperium. Blood. 2016;128(19):2343-2349.
49 GS Alotaibi, C Wu, A Senthilselvan, MS McMurtry. The validity of ICD codes coupled with imaging procedure codes for identifying acute venous thromboembolism using administrative data. Vasc Med. 2015;20(4):364-368.
50 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):S81-S90.
51 World Health Organization (WHO). Preterm birth. Accessed August 28, 2023.
PDF

Accesses

Citations

Detail

Sections
Recommended

/