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Am J Perinatol 2025; 42(05): 564-571
DOI: 10.1055/a-2419-9036
SMFM Fellowship Series Article

Hereditary Hemorrhagic Telangiectasia: Pregnancy and Delivery-Specific Considerations and Outcomes

Virginia Y. Watkins 
1   Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
,
Mira L. Estin
1   Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
,
Amanda M. Craig 
1   Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
,
Sarah K. Dotters-Katz
1   Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
,
Jerome J. Federspiel 
1   Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
2   Department of Population Health Sciences, Duke University Hospital, Durham, North Carolina
› Institutsangaben Funding J.J.F. was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number K12HD103083. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Objective

Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy- and delivery-specific data remain limited. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT.

Study Design

This retrospective cohort study used the Nationwide Readmissions Database to identify patients with HHT diagnosis on delivery between 2010 and 2021. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included nontransfusion SMM, preterm birth, stillbirth, prelabor rupture of membranes or preterm prelabor rupture of membranes, cesarean delivery, respiratory bleeding, cerebrovascular complications, patient disposition, and length of stay. Trends in the prevalence of HHT at delivery were assessed with logistic regression. Logistic regression analyses, adjusting for age, payer, zip code income, hospital size, and teaching status, were also used to produce adjusted relationships between HHT status and outcomes.

Results

The cohort of 21,698,861 delivered pregnancies corresponded to a national estimate of 44,325,599. Of those, 612 (national estimate: 1,265; 2.8 per 100,000) had a diagnosis of HHT. A steady rise in the HHT diagnosis rate during pregnancy from 2010 to 2021 (1.7 per 100,000 in 2010, 3.8 per 100,000 in 2021, p < 0.001 for trend) was seen. Patients with HHT were significantly more likely to experience SMM compared with patients without HHT (7.8 vs. 1.7%, adjusted relative risk [aRR]: 4.49 [95% confidence interval, CI: 3.06, 6.58]). Rates of preterm birth (14.2 vs. 8.5%, aRR: 1.57 [95% CI: 1.22, 2.03]), cesarean delivery (41.0 vs. 32.9%, aRR: 1.23 [95% CI: 1.07, 1.41]), respiratory bleeding (2.1 vs. <0.1%, aRR: 94.44 [56.64, 157.46]), and cerebrovascular complications (0.9 vs. <0.1%, aRR: 22.89 [9.89, 52.96]) were higher in patients with HHT than non-HHT patients. There was no difference in stillbirth rates between groups.

Conclusion

Patients with HHT have higher rates of SMM and adverse delivery outcomes when compared with the baseline population.

Key Points

  • There was a steady rise in the rates of HHT during pregnancy from 2010 to 2021.

  • Patients with HHT are more likely to experience SMM.

  • Patients with HHT are more likely to have a preterm delivery and cesarean delivery.

Keywords

hereditary hemorrhagic telangiectasia - severe maternal morbidity - preterm birth - cesarean delivery


Publikationsverlauf

Eingereicht: 27. Februar 2024

Angenommen: 20. September 2024

Accepted Manuscript online:
24. September 2024

Artikel online veröffentlicht:
10. Oktober 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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