Download PDF
CC BY-NC-ND 4.0 · Thromb Haemost 2019; 119(04): 606-617
DOI: 10.1055/s-0039-1677733
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Endometriosis and Recurrent Pregnancy Loss as New Risk Factors for Venous Thromboembolism during Pregnancy and Post-Partum: The JECS Birth Cohort

Mayumi Sugiura-Ogasawara
1   Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
Takeshi Ebara
2   Department of Occupational and Environmental Health, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
Taro Matsuki
2   Department of Occupational and Environmental Health, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
Yasuyuki Yamada
2   Department of Occupational and Environmental Health, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
3   Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
,
Toyonori Omori
4   Department of Health Care Policy and Management, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
5   National Center for Child Health and Development, Tokyo, Japan
,
Yosuke Matsumoto
1   Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
Sayaka Kato
2   Department of Occupational and Environmental Health, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
6   Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
Hirohisa Kano
2   Department of Occupational and Environmental Health, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
Takahiro Kurihara
2   Department of Occupational and Environmental Health, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
Shinji Saitoh
6   Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
Michihiro Kamijima
2   Department of Occupational and Environmental Health, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
,
and the Japan Environment & Children's Study (JECS) Group › Author Affiliations Funding This study was funded by the Ministry of the Environment, Government of Japan.
Further Information

Publication History

11 October 2018

17 December 2018

Publication Date:
05 February 2019 (online)

Also available at
   Permissions and Reprints

Abstract

Background Since venous thromboembolism (VTE) is one of the causes of maternal mortality, several guidelines recommend prophylaxis using low molecular weight heparin for women in high-risk groups. The number of large population-based studies examining predictors for VTE has been limited, and there has been no study based on a Japanese population.

Objective Our objective was to examine VTE risk factor during the pregnancy and post-partum period.

Materials and Methods A nationwide birth cohort study known as the ‘Japan Environment and Children's Study (JECS)’ was conducted by the Ministry of the Environment. The subjects consisted of 103,070 pregnancies recruited by the JECS between January 2011 and March 2014. Pregnant women completed the questionnaires during the first and second/third trimester. Their medical records were transcribed by physicians or research coordinators at registration, just after delivery and at 1 month after delivery.

Results The frequency of VTE was 7.5 per 10,000 pregnancies (77 of 103,070) during the pregnancy and post-partum period. After the adjustment of multiple covariates for each factor, endometriosis and recurrent pregnancy loss (RPL) were identified as novel independent risk factors for VTE. Adjusted odds ratios were as follows: 2.70 (95% confidence interval, 1.21–6.00) for endometriosis and 6.13 (2.48–15.16) for RPL. Threatened abortion, threatened pre-term birth, pre-term birth and caesarean section were ascertained to be risk factors for VTE.

Conclusion Careful attention should be given to novel predictors, such as endometriosis and a history of RPL, to prevent VTE during the pregnancy and post-partum period.

Keywords

venous thromboembolism - birth cohort study - pregnancy - post-partum - recurrent pregnancy loss

Authors' Contributions

The JECS group conducted the nationwide study project. M.S.O. designed the present study, analysed the data and wrote the first draft of the manuscript. T.E. organized the study team and was responsible for obtaining and analysing the data. M.K., a member of the JECS Steering Committee, was responsible for data acquisition and supervision of the study. M.K. and T.O. took the initiative in the launch of the Aichi regional sub-cohort of JECS. T.M. analysed the data. Y.Y., T.O., Y.M., S.K. and S.S. were responsible for data acquisition. All authors interpreted the data, contributed to the writing of the manuscript and revised it critically for important intellectual content.


Note

Data sharing is not permitted by the JECS due to a government policy restricting the deposition of data containing personal information. See the reference for more details.[12]


Supplementary Material

 

  • References

  • 1 Sultan AA, West J, Grainge MJ. , et al. Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study. BMJ 2016; 355: i6253
    CrossrefPubMedSearch in Google Scholar
  • 2 Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). Chest 2012; 141: 691-736
    CrossrefPubMedSearch in Google Scholar
  • 3 Royal College of Obstet Gynecol. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium. RCOG Green-top Guideline No. 37a;2015
    PubMed
  • 4 Brill-Edwards P, Ginsberg JS, Gent M. , et al. Recurrence of Clot in This Pregnancy Study Group. Safety of withholding antepartum heparin in women with a previous episode of venous thromboembolism. N Engl J Med 2000; 343: 1439-1444
    CrossrefPubMedSearch in Google Scholar
  • 5 Sultan AA, Tata LJ, West J. , et al. Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom. Blood 2013; 121 (19) 3953-3961
    CrossrefPubMedSearch in Google Scholar
  • 6 Bain E, Wilson A, Tooher R, Gates S, Davis LJ, Middleton P. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev 2014; 2 (02) CD001689
    PubMedSearch in Google Scholar
  • 7 Minakami H, Maeda T, Fujii T. , et al. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 edition. J Obstet Gynaecol Res 2014; 40 (06) 1469-1499
    CrossrefPubMedSearch in Google Scholar
  • 8 Editorial Committee on Japanese Guidelines for Prevention of Venous Thromboembolism. Japanese guidelines for prevention of venous thromboembolism. Tokyo, Japan: Medical Front International Limited; 2004: 47-54
    Search in Google Scholar
  • 9 James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol 2006; 194 (05) 1311-1315
    CrossrefPubMedSearch in Google Scholar
  • 10 Kawamoto T, Nitta H, Murata K. , et al; Working Group of the Epidemiological Research for Children's Environmental Health. Rationale and study design of the Japan Environment and Children's Study (JECS). BMC Public Health 2014; 14: 25
    CrossrefPubMedSearch in Google Scholar
  • 11 Michikawa T, Nitta H, Nakayama SF. , et al; Japan Environment and Children's Study Group. Baseline profile of participants in the Japan Environment and Children's Study (JECS). J Epidemiol 2018; 28 (02) 99-104
    CrossrefPubMedSearch in Google Scholar
  • 12 Suzuki K, Shinohara R, Sato M, Otawa S, Yamagata Z. Association between maternal smoking during pregnancy and birth weight: an appropriately adjusted model from the Japan Environment and Children's Study. J Epidemiol 2016; 26 (07) 371-377
    CrossrefPubMedSearch in Google Scholar
  • 13 Japan Environment and Children's Study. Tokyo: Ministry of the Environment. Available at: http://www.env.go.jp/en/chemi/hs/jecs/ [updated August 12, 2016]. Accessed August 16, 2016
    PubMed
  • 14 Ishitsuka K, Nakayama SF, Kishi R. , et al. Japan Environment and Children's Study: backgrounds, activities, and future directions in global perspectives. Environ Health Prev Med 2017; 22 (01) 61
    CrossrefPubMedSearch in Google Scholar
  • 15 National Institute for Environmental Studies/National Centre for Japan Environment and Children's Study, Japan Environment and Children's Study (JECS) Study Protocol (ver. 1.4). Available at: https://www.env.go.jp/chemi/ceh/outline/data/jecs-study_protocol_14_en.pdf . Accessed January 18, 2017
    PubMed
  • 16 Giudice LC. Clinical practice. Endometriosis. N Engl J Med 2010; 362 (25) 2389-2398
    CrossrefPubMedSearch in Google Scholar
  • 17 Ageno W, Manfredi E, Dentali F. , et al. The incidence of venous thromboembolism following gynecologic laparoscopy: a multicenter, prospective cohort study. J Thromb Haemost 2007; 5 (03) 503-506
    CrossrefPubMedSearch in Google Scholar
  • 18 Croles FN, Nasserinejad K, Duvekot JJ, Kruip MJ, Meijer K, Leebeek FW. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and Bayesian meta-analysis. BMJ 2017; 359: j4452
    CrossrefPubMedSearch in Google Scholar
  • 19 Miyakis S, Lockshin MD, Atsumi T. , et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4 (02) 295-306
    CrossrefPubMedSearch in Google Scholar
  • 20 Pereza N, Ostojić S, Kapović M, Peterlin B. Systematic review and meta-analysis of genetic association studies in idiopathic recurrent spontaneous abortion. Fertil Steril 2017; 107 (01) 150-159
    CrossrefPubMedSearch in Google Scholar
  • 21 Hayashi Y, Sasaki H, Suzuki S. , et al. Genotyping analyses for polymorphisms of ANXA5 gene in patients with recurrent pregnancy loss. Fertil Steril 2013; 100 (04) 1018-1024
    CrossrefPubMedSearch in Google Scholar
  • 22 Liu N, Vigod SN, Farrugia MM, Urquia ML, Ray JG. Venous thromboembolism after induced abortion: a population-based, propensity-score-matched cohort study in Canada. Lancet Haematol 2018; 5 (07) e279-e288
    PubMedSearch in Google Scholar
  • 23 Kimura R, Honda S, Kawasaki T. , et al. Protein S-K196E mutation as a genetic risk factor for deep vein thrombosis in Japanese patients. Blood 2006; 107 (04) 1737-1738
    CrossrefPubMedSearch in Google Scholar
  • 24 Kaandorp SP, Goddijn M, van der Post JAM. , et al. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N Engl J Med 2010; 362 (17) 1586-1596
    CrossrefPubMedSearch in Google Scholar
  • 25 Hansen AT, Schmidt M, Horváth-Puhó E. , et al. Preconception venous thromboembolism and placenta-mediated pregnancy complications. J Thromb Haemost 2015; 13 (09) 1635-1641
    CrossrefPubMedSearch in Google Scholar
  • 26 Sugiura-Ogasawara M, Suzuki S, Ozaki Y, Katano K, Suzumori N, Kitaori T. Frequency of recurrent spontaneous abortion and its influence on further marital relationship and illness: the Okazaki Cohort Study in Japan. J Obstet Gynaecol Res 2013; 39 (01) 126-131
    CrossrefPubMedSearch in Google Scholar