Abstract
Objective The impact of type 1 DM (T1DM) on thromboembolism in pregnancy is uncertain. We hypothesized that T1DM is associated with higher rates of thrombotic events during pregnancy and the postpartum period.
Study Design This is a retrospective cohort study utilizing the National Inpatient Sample database from HCUP/AHRQ for 2017–2019. Pregnant and postpartum patients with a history of T1DM were compared to those without. The primary outcome was a composite diagnosis of any thrombotic disease (pulmonary embolism [PE], deep vein thrombosis [DVT], cerebral vascular thrombosis [CVT], or other thromboses). Secondary outcomes were the diagnosis of each individual type of thromboembolic event. Groups were compared via student's test, chi-squared, and logistic regression analyses, controlling for confounders including age, race, obesity, tobacco use, cHTN, asthma, anemia, and cesarean section.
Results A total of 2,361,711 subjects met the criteria. Patients with T1DM encompassed 0.4% of subjects (n = 9,983). T1DM subjects were more likely to be younger, non-Hispanic white, obese, tobacco users, chronic hypertensive, asthmatic, and have a history of cesarean (all p < 0.001). They were less likely to be in the top income quartile. Thromboembolic events occurred more frequently in those with T1DM (0.45% vs. 0.20%, p < 0.001). DVT was the most common event (0.25%). After controlling for confounders, T1DM remained independently associated with any thromboembolic event in pregnancy (adjusted odds ratio [aOR] = 2.19, 95% confidence interval [CI]: 1.49–3.23), PE (aOR = 3.59, 95% CI: 1.65–7.82), and DVT (aOR = 2.43, 95% CI: 1.43–4.14).
Conclusion T1DM is associated with an increased risk of thromboembolic events in pregnancy.
Key Points
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T1DM is independently associated with VTE.
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PE and DVT are the most common events.
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T1DM has an impact on VTE similar to obesity.
Keywords
Type 1 diabetes mellitus - VTE - thromboembolism - pregnancy
