Hypertensive disorders and pulmonary embolism during pregnancy and postpartum

Abstract

Venous thromboembolism (VTE) is one of the leading cause of maternal morbidity and mortality in pregnancy and post-partum. The association between both the chronic hypertension or preeclampsia and the risk of pulmonary embolism (PE) is still under debate. The aim of the study was to estimate the risk of PE in women hospitalized with preeclampsia during pregnancy and post-partum. All women aged 18–45 years who delivered after 20 weeks of amenorrhea between 2010 and 2015 were selected in the French hospital discharge database. In these women, hospital stays with a diagnosis of preeclampsia between the 20th week of amenorrhea and up to 6 weeks postpartum were identified. Chronic hypertension before pregnancy was also identified using the French health insurance claim database. Hospitalizations for PE after the diagnosis of preeclampsia and up to 6 weeks postpartum were selected in the same database. Adjusted Poisson regressions were used to estimate incidence rate ratios (IRR) comparing the incidence of PE following preeclampsia or chronic hypertension versus incidence in women without those conditions. Between 2010 and 2015, 4,483,852 women had a delivery and were included in the study. Hospitalization for preeclampsia occurred in 1.9% of these women. Among women with preeclampsia, PE occurred in 1,087 during pregnancy and in 1,693 during postpartum. Preeclampsia was associated with a significantly increased risk of PE during postpartum (adjIRR = 2.6 95%CI [2.2–3.1]) but not during pregnancy (adjIRR = 1.2 95%CI [0.8–1.7]). Chronic hypertension before pregnancy was associated with a significantly higher risk of PE during pregnancy (adjIRR = 1.6 95%CI [1.1–2.2]) and postpartum (adjIRR = 1.4 95%CI [1.0–1.8]). This study highlighted the importance of monitoring women for PE after a hospitalization for preeclampsia and women with chronic hypertension during pregnancy and postpartum.