Developing a model for predicting venous thromboembolism in obese pregnant women in a national study.
INTRODUCTION: Venous thromboembolism (VTE) in pregnancy and postpartum is a leading cause of maternal morbidity and mortality in developed countries, where obesity is a known risk for this complication. Current guidelines vary in which patients qualify for VTE prophylaxis, precluding a uniform approach for management. We sought to derive a risk prediction model for VTE in obese pregnant women. MATERIALS AND METHODS: We performed a retrospective cohort analysis using the Consortium on Safe Labor (CSL) database. Women ages 16-45 who were pregnant with singletons and had an obese body mass index (>30 kg/m2) were included in our study population. Multivariable logistic regression was used in order to identify predictors of venous thromboembolism. RESULTS: Of the 83,500 women who met inclusion criteria, on average women were 27.8 years old, 38.6 weeks gestation, with body mass index of 35.8, and cesarean delivery incidence of 35.2%. 109 women (0.13%) experienced a VTE event. Independent predictors of VTE in our final multivariable predictive model included: mode of delivery, body mass index, pregestational diabetes, chronic heart disease, preeclampsia, blood transfusion (intrapartum or postpartum), prenatal history of thromboembolic disorder, and postpartum maternal length of stay. A receiver operating characteristic curve was developed to assess the model; area under the curve was 0.826. CONCLUSIONS: We developed a strong predictive model using a large, retrospective database to distinguish risk of VTE in obese pregnant women, which may provide the foundation for future protocol development of obstetrical thromboprophylaxis in obese women.
Ellis-Kahana, J; Sparks, AD; Gimovsky, AC; James, AH; Ahmadzia, HK
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