Am J Perinatol 2020; 37(04): 384-389
DOI: 10.1055/s-0039-1679867
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lower Extremity Blood Flow Velocity in Obese versus Nonobese Pregnant Women

Eryn H. Dutta
1   Department of Obstetrics and Gynecology, Naval Medical Center Camp Lejeune, Camp Lejeune, North Carolina
,
Ralph N. Burns
2   Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
,
Luis D. Pacheco
3   Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas
4   Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas
,
Caroline C. Marrs
4   Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas
,
Aristides Koutrouvelis
3   Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas
,
Gayle L. Olson Koutrouvelis
4   Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas
› Author Affiliations
Funding This study is supported by Ruth Hargrave Fellowship Endowment in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston.
Further Information

Publication History

01 August 2018

12 January 2019

Publication Date:
19 February 2019 (online)

Abstract

Objective Obesity and pregnancy are risk factors for venous thromboembolism (VTE). In nonpregnant individuals, abdominal obesity is associated with venous insufficiency. This study aimed to compare venous Doppler volume flow and velocity in the lower extremities of obese versus nonobese women.

Study Design A prospective cohort study was performed. Duplex ultrasound examined bilateral lower extremity venous flow and velocity (time-averaged mean velocity, TAMV). Flow was analyzed at the superficial femoral (SFV), distal external iliac (DEI), common femoral, profunda femoris, and popliteal veins. Mann–Whitney U-test, Spearman's correlation, and chi-square tests were used, with a significance of p < 0.05.

Results Left SFV TAMV and volume flow were higher in the obese group (5.1 [4.1–5.7] vs. 2.8 [1.7–3.4] cm/second; p < 0.001) and (89 [73–119] vs. 48 [26–62] cm/minute; p = 0.005). Significant differences were noted for right DEI flow (obese 326 [221–833] vs. nonobese 182 [104–355] cm/minute; p = 0.049). The right femoral profunda flow was also higher in obese (49 [40–93] cm/minute) compared with nonobese (31 [22–52] cm/minute; p = 0.041).

Conclusion Volume flow and TAMV in the lower extremities of obese gravidas are higher compared with nonobese ones. Thus, the increased risk of VTE among obese pregnant women may not be caused by venous stasis.

Note

This study was presented in a poster at the Society of Maternal–Fetal Medicine's 36th Annual Pregnancy Meeting, Atlanta, GA, February 2016. The views expressed in this manuscript are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. Eryn H. Dutta, DO, is a military service member. This work was prepared as part of her official duties. Title 17, USC, §105 provides that “Copyright protection under this title is not available for any work of the US Government.” Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.


 
  • References

  • 1 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
  • 2 Jacobsen AF, Drolsum A, Klow NE, Dahl GF, Qvigstad E, Sandset PM. Deep vein thrombosis after elective cesarean section. Thromb Res 2004; 113 (05) 283-288
  • 3 Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. Available at: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html . Accessed on February 23, 2016
  • 4 American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol 2013; 121 (01) 213-217
  • 5 James A. ; Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 2011; 118 (03) 718-729
  • 6 Willenberg T, Schumacher A, Amann-Vesti B. , et al. Impact of obesity on venous hemodynamics of the lower limbs. J Vasc Surg 2010; 52 (03) 664-668
  • 7 Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH. Pregnancy complications and birth outcomes in obese and normal-weight women: effects of gestational weight change. Obstet Gynecol 1996; 87 (03) 389-394
  • 8 Widmer LK. Peripheral Venous Disorders, Basel III Study. Bern, Switzerland: Hans Huber; 1978
  • 9 Abramson JH, Hopp C, Epstein LM. The epidemiology of varicose veins. A survey in western Jerusalem. J Epidemiol Community Health 1981; 35 (03) 213-217
  • 10 van Rij AM, De Alwis CS, Jiang P. , et al. Obesity and impaired venous function. Eur J Vasc Endovasc Surg 2008; 35 (06) 739-744
  • 11 Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium--a register-based case-control study. Am J Obstet Gynecol 2008; 198 (02) 233.e1-233.e7
  • 12 Ferrante Jr AW. Obesity-induced inflammation: a metabolic dialogue in the language of inflammation. J Intern Med 2007; 262 (04) 408-414