Time trends in antithrombotic therapy during pregnancy and maternal and perinatal outcomes in the Netherlands (2013-19): a nationwide cohort study.

IF 15.4 1区医学 Q1 HEMATOLOGY Lancet Haematology Pub Date : 2024-12-01 DOI:10.1016/S2352-3026(24)00313-2

Qingui Chen, Nienke van Rein, Lisa Broeders, Saskia Middeldorp, Kitty W M Bloemenkamp, Suzanne C Cannegieter, Luuk J J Scheres

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Abstract

Background: Considering the paucity of data, we aimed to describe nationwide time trends in antithrombotic therapy during pregnancy and risks of maternal and perinatal outcomes in the Netherlands.

Methods: In this nationwide cohort study, all female individuals aged 16-45 years with delivery records in the Dutch perinatal registry between Jan 1, 2013, and Dec 31, 2019, and their infants, were included. Individually linked data from Statistics Netherlands on outpatient medication prescriptions, in-hospital diagnoses, and mortality were used to evaluate time trends in antithrombotic therapy during pregnancy, and risks of maternal and perinatal outcomes (including thromboembolism, bleeding, preeclampsia and eclampsia, and low birthweight).

Findings: A total of 1 122 711 pregnancies and 1 139 116 infants were included (median maternal age 30·5 years [IQR 27·3-33·7]; 886 085 [78·9%] White; median gravidity 2 (IQR 1-3); and median gestational age at delivery 39 weeks [IQR 38-40]). Low-molecular-weight heparin (LMWH) was the most commonly (more than 99%) prescribed anticoagulants during pregnancy, which slightly increased from 0·7% (1063 of 163 479) in 2013 to 0·9% (1352 of 158 654) in 2019. LMWH was generally started at 5-8 weeks' gestation when oral anticoagulant prescriptions dropped. Antiplatelet drug prescriptions increased from 0·7% (1129 of 163 479) to 4·8% (7671 of 158 654), which primarily initiated around week 12. Maternal risks of venous and arterial thromboembolism and bleeding remained constant from 2013 to 2019; the risk of preeclampsia and eclampsia gradually increased from 1·70% (95% CI 1·63-1·76) in 2013 to 2·05% (1·98-2·13) in 2017, after which it decreased to 1·83% (1·77-1·90) in 2019. There was a significant decrease (2019 vs 2013) in low birthweight (adjusted odds ratio 0·92 [0·90-0·94]; p<0·0001), whereas 28-day neonatal bleeding risk remained unchanged.

Interpretation: Exposure to anticoagulants during pregnancy is not uncommon, and health-care providers and female individuals of reproductive age should be mindful of this to avoid unintended oral anticoagulant exposure. Adhering to guidelines for aspirin use to prevent preeclampsia might lead to a population-level reduction in disease burden and potential improvement in neonatal prognosis.

Funding: None.

Translation: For the Dutch translation of the abstract see Supplementary Materials section.

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荷兰（2013-19）妊娠期间抗血栓治疗的时间趋势以及孕产妇和围产期结局：一项全国性队列研究

背景：考虑到数据的缺乏，我们旨在描述荷兰全国范围内妊娠期间抗血栓治疗的时间趋势以及孕产妇和围产期结局的风险。方法：在这项全国性队列研究中，纳入了2013年1月1日至2019年12月31日期间在荷兰围产期登记处有分娩记录的所有16-45岁女性及其婴儿。来自荷兰统计局的门诊药物处方、住院诊断和死亡率的单独关联数据用于评估妊娠期间抗血栓治疗的时间趋势，以及孕产妇和围产期结局（包括血栓栓塞、出血、先兆子痫和子痫以及低出生体重）的风险。结果：共纳入1 122 711例妊娠和1 139 116例婴儿(中位产妇年龄30.5岁[IQR 27.3 - 33.7]；886 085[78·9%]白；中位重力2 (IQR 1-3)；分娩时中位胎龄39周[IQR 38-40])。低分子肝素（LMWH）是妊娠期间最常见的抗凝剂（超过99%），从2013年的0.7%（163 479例中的1063例）略微增加到2019年的0.9%（158 654例中的1352例）。低分子肝素一般在妊娠5-8周口服抗凝药处方减少时开始使用。抗血小板药物处方从0.7%（163 479例中的1129例）增加到4.8%（158 654例中的7671例），主要在第12周左右开始。2013 - 2019年孕产妇静脉和动脉血栓栓塞及出血风险保持不变；子痫前期和子痫的风险从2013年的1.70% （95% CI 1.63 - 1.76）逐渐上升到2017年的2.05%(1.98 - 2.13)，之后下降到2019年的1.83%（1.77 - 1.90）。低出生体重显著下降（2019年与2013年相比）(校正优势比为0.92 [0.90 - 0.94]；解释：怀孕期间接触抗凝血剂并不罕见，卫生保健提供者和育龄女性应注意这一点，以避免意外的口服抗凝血剂暴露。坚持使用阿司匹林预防子痫前期的指南可能导致人群水平的疾病负担减少和新生儿预后的潜在改善。资金:没有。翻译：关于摘要的荷兰语翻译，见补充材料部分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Haematology HEMATOLOGY-

CiteScore

26.00

自引率

0.80%

发文量

323

期刊介绍： Launched in autumn 2014, The Lancet Haematology is part of the Lancet specialty journals, exclusively available online. This monthly journal is committed to publishing original research that not only sheds light on haematological clinical practice but also advocates for change within the field. Aligned with the Lancet journals' tradition of high-impact research, The Lancet Haematology aspires to achieve a similar standing and reputation within its discipline. It upholds the rigorous reporting standards characteristic of all Lancet titles, ensuring a consistent commitment to quality in its contributions to the field of haematology.