OC 25.3 - A multicentre cohort study evaluating pregnancy loss in patients with von Willebrand disease and unspecified bleeding disorders

Sunday, June 25, 2023

15:15 – 15:30 ET

Room: 511

Session Available As: On-Demand

Presenting Author(s)

Leslie Skeith, MD

Associate Professor
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada

Co-Author(s)

Paula James, MD

Professor
Department of Medicine, Queen's University, Kingston, ON, Canada
Kingston, Ontario, Canada
Peter Kouides, MD

Physician - Hematology/Oncology
Mary M. Gooley Hemophilia Centre, Rochester, NY, USA
Rochester, New York, United States
KU

Kelsey Uminski, MD, FRCPC (she/her/hers)

Hemostasis Fellow
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada, Alberta, Canada
Lisa Duffett, MD, MSc

Assistant Professor
Department of Medicine, University of Ottawa, Ottawa, ON, Canada
Ottawa, Ontario, Canada
Shannon Jackson, MD (she/her/hers)

Hematologist, Providence Health Care
Providence Hematology, St. Paul’s Hospital, Vancouver, BC, Canada
Vancouver, British Columbia, Canada
Michelle Sholzberg, MDCM, FRCPC, MSc., MDCM, FRCPC, MSc

Head, Division of Hematology-Oncology
Departments of Medicine, and Laboratory Medicine and Pathobiology, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
Toronto, Ontario, Canada
Margaret V. Ragni, MD, MPH (she/her/hers)

Professor of Medicine and Clinical and Translational Science
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Pittsburgh, Pennsylvania, United States
Adam Cuker, MD, MS (he/him/his)

Associate Professor
Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Philadelphia, Pennsylvania, United States
MO

Maeve O'Beirne

Associate Professor
Department of Family Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
SR

Sarah Rubinstein

Student
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
Julia C. Hews-Girard, PhD (she/her/hers)

Adjunct Assistant Professor
University of Calgary, School of Nursing
Calgary, Alberta, Canada
NR

Natalia Rydz

Clinical Associate Professor
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
DG

Dawn Goodyear

Clinical Associate Professor
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, AB, Canada
Calgary, Alberta, Canada
JB

Jill Baxter

Research Coordinator
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
Andra James, MD, MPH (she/her/hers)

Professor Emeritus of Obstetrics & Gynecology - Division of Maternal-Fetal Medicine
Duke University, Durham, NC, USA
Durham, North Carolina, United States
DG

David Garcia

Professor
Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
Seattle, Washington, 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
MP

Man-Chiu Poon

Clinical Professor; Professor Emeritus of Medicine - Paediatrics and Oncology
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada

Background: While the risk of bleeding around pregnancy is well described in patients with von Willebrand disease (VWD), the risk of pregnancy loss is less certain. It has been hypothesized that abnormal angiogenesis may lead to pregnancy loss in patients with VWD.

Aims: To describe pregnancy loss risk in females with VWD, compared to those with a similar mucocutaneous bleeding phenotype (nonspecific platelet disorder or bleeding disorder NOS), or to controls without a known bleeding disorder.

Methods: Consecutive female patients were approached in specialty bleeding disorder clinics to complete a questionnaire about their pregnancy history (REB14-1437). The VWD group was defined as VWF:Antigen (Ag) and VWF:Activity (Act) levels < 0.50 IU/mL on >=2 occasions and a Condensed MCMDM-1 score of >=4, and the bleeding disorder NOS group had levels >=0.50 IU/mL on >=2 occasions and a score >=4. The control group was recruited from a low-risk maternity clinic. Study funding: CSL Behring Canada, University of Calgary.

Results: Since 2014, 5 Canadian and 3 US centres have enrolled 438 participants to date (7 more remain). Among the VWD group, 115 (76%) were Type 1, 33 (22%) Type 2, and 3 (2%) Type 3. The proportion of Type 1 participants with VWF:Act < 0.30 IU/mL was 55%. A total of 472 pregnancies were in the VWD group, 462 in the bleeding disorder NOS group, and 264 in the control group, excluding current pregnancies. To date, the proportion of total spontaneous losses was 29.5% in the VWD group, 28.1% in the bleeding disorder NOS group, and 26.5% in the controls. A final comparison between groups will be presented at the ISTH congress.

Conclusion(s): Our study provides novel data on the pregnancy loss risk among patients with VWD and those with a similar bleeding phenotype. On preliminary review, the proportion of aggregate loss appears similar across groups.

Learning Objectives:

Describe the rationale for evaluating pregnancy loss in von Willebrand disease and unspecified bleeding disorders
Interpret the study results for patients with von Willebrand disease
Interpret the study results for patients with unspecified bleeding disorders