OC 25.2 - Prevalence and Risk Factors for Thromboembolism in Women with Sickle Cell Disease during Pregnancy

Sunday, June 25, 2023

15:00 – 15:15 ET

Room: 511

Session Available As: On-Demand

Presenting Author(s)

Shreya Agarwal, MD (she/her/hers)

Clinical Postdoctoral fellow
Nationwide Children's Hospital
Columbus, Ohio, United States

Co-Author(s)

JS

Joseph R. Stanek

Biostatistician
Biostatistics Resource at Nationwide Children's Hospital
Columbus, Ohio, United States
SV

Sara K. Vesely

Professor
Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma, Oklahoma City, OK, USA
Oklahoma City, Oklahoma, United States
SC

Susan E. Creary

Associate Professor
Division of Hematology/Oncology/BMT, Nationwide Children's Hospital
Columbus, Ohio, United States
RC

Robert M. Cronin

Associate Professor
Department of Internal Medicine, Ohio State University, Columbus, OH
Columbus, Ohio, United States
AR

Andrea H. Roe

Assistant Professor
Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
Philadelphia, Pennsylvania, United States
Sarah H. O'Brien, MD, MSc

Associate Professor
Division of Hematology/Oncology/BMT, Nationwide Children's Hospital
Columbus, Ohio, United States

Background: Pregnancy and sickle cell disease (SCD) both individually carry a risk of thromboembolism (TE). Hence, pregnancy in women with SCD may further enhance the prothrombotic effect of the underlying disease.

Aims: 1) To determine the prevalence of venous and arterial TE during pregnancy in women with SCD and compare the risk to a control cohort without SCD. 2) Within the SCD cohort, to identify risk factors for pregnancy-related TE.

Methods: Administrative claims data from the United States Centers for Medicare and Medicaid Service Analytic eXtract from 2006-2018 were used. Study population included women with SCD from the start of their first pregnancy until one year postpartum and a control cohort of pregnant women without SCD of similar age and race. Pregnancy status, TE, and patient-specific, comorbid, and historical risk-factors of interest were identified with ICD-9 or 10 codes. Logistic regression analyses were used to identify risk factors.

Results: We identified 6,440 pregnant women with SCD and 17,278 controls. A total of 1260 (19.6%) TE were observed in women with SCD compared to 326 (1.9%) in controls. Within the SCD cohort, deep vein thrombosis was the most common type of TE (39% of the events), followed by pulmonary embolism (29%), stroke (25%), and myocardial infarction (7%). Pregnant/postpartum women with SCD had ten times higher odds of arterial or venous TE compared to controls (p < 0.001) (Table 1).
On multivariable analysis, patient specific factors (age, genotype), comorbid conditions (hypertension, obesity, diabetes) and concurrent or historical thrombosis were identified as risk factors for TE during pregnancy and postpartum (Table 2). Pregnancy specific factors (pre-eclampsia, multigestational pregnancy) were not associated with increased TE risk.

Conclusion(s): We demonstrated that risk of pregnancy-related TE in women with SCD is significantly higher than in the general pregnant population. Hence, pregnant/postpartum women with SCD and high-risk features might be candidates for thromboprophylaxis.

Learning Objectives:

Upon completion, participant will be able to understand the pathophysiology of thrombosis in pregnancy and sickle cell disease (SCD).
Upon completion, participant will be able to compare and contrast the rates of thromboembolic events in pregnant women with and without SCD.
Upon completion, participant will be able to recognize the risk factors for pregnancy-related thromboembolism in women with SCD.