Pregnancy loss in individuals with von Willebrand disease and unspecified mucocutaneous bleeding disorders: A multicentre cohort study.

blood coagulation disorders pregnancy spontaneous abortion von Willebrand disease

Journal

Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508

Informations de publication

Date de publication:
23 Oct 2024
Historique:
received: 19 03 2024
revised: 09 07 2024
accepted: 25 09 2024
medline: 26 10 2024
pubmed: 26 10 2024
entrez: 25 10 2024
Statut: aheadofprint

Résumé

While bleeding around pregnancy is well described in von Willebrand disease (VWD), risk of pregnancy loss is less certain. We aimed to describe the frequency of pregnancy loss in females with VWD, compared with those with a similar mucocutaneous bleeding phenotype and no VWD, or compared with non-bleeding disorder controls. Female patients were consecutively approached in 8 specialty bleeding disorder clinics between 2014-2023. The VWD group was defined as having VWF:Antigen (Ag) and VWF:Activity (Act) levels, each <0.50 IU/mL on ≥2 occasions, and a Condensed MCMDM-1 score of ≥4. The non-VWD mucocutaneous bleeding disorder group had VWF levels ≥0.50 IU/mL on ≥2 occasions and a MCMDM-1 score ≥4. A non-bleeding disorder control group was recruited in pregnancy from a low-risk maternity clinic. There were 150 females in the VWD group, 145 in the non-VWD mucocutaneous bleeding disorder group, and 137 in the control group. There was a similar frequency of individuals with ≥1 loss in the VWD group (45.3%, 68/150), the non-VWD group (56.6%, 82/145) (-11.2%, 97.5% CI -24.2, 1.8%), and the non-bleeding disorder control group (37.2%, 51/137) (8.1%, 97.5% CI -4.9%, 21.1%). Using a logistic regression, the odds ratio of pregnancy losses in the VWD group versus non-VWD group was 0.94 (95% CI 0.65, 1.36). All groups experienced more recurrent losses compared to the literature. There was no statistically significant difference in risk of pregnancy loss between females with VWD, females with a similar mucocutaneous bleeding phenotype, and with non-bleeding disorder controls.

Sections du résumé

BACKGROUND BACKGROUND
While bleeding around pregnancy is well described in von Willebrand disease (VWD), risk of pregnancy loss is less certain. We aimed to describe the frequency of pregnancy loss in females with VWD, compared with those with a similar mucocutaneous bleeding phenotype and no VWD, or compared with non-bleeding disorder controls.
METHODS METHODS
Female patients were consecutively approached in 8 specialty bleeding disorder clinics between 2014-2023. The VWD group was defined as having VWF:Antigen (Ag) and VWF:Activity (Act) levels, each <0.50 IU/mL on ≥2 occasions, and a Condensed MCMDM-1 score of ≥4. The non-VWD mucocutaneous bleeding disorder group had VWF levels ≥0.50 IU/mL on ≥2 occasions and a MCMDM-1 score ≥4. A non-bleeding disorder control group was recruited in pregnancy from a low-risk maternity clinic.
RESULTS RESULTS
There were 150 females in the VWD group, 145 in the non-VWD mucocutaneous bleeding disorder group, and 137 in the control group. There was a similar frequency of individuals with ≥1 loss in the VWD group (45.3%, 68/150), the non-VWD group (56.6%, 82/145) (-11.2%, 97.5% CI -24.2, 1.8%), and the non-bleeding disorder control group (37.2%, 51/137) (8.1%, 97.5% CI -4.9%, 21.1%). Using a logistic regression, the odds ratio of pregnancy losses in the VWD group versus non-VWD group was 0.94 (95% CI 0.65, 1.36). All groups experienced more recurrent losses compared to the literature.
CONCLUSIONS CONCLUSIONS
There was no statistically significant difference in risk of pregnancy loss between females with VWD, females with a similar mucocutaneous bleeding phenotype, and with non-bleeding disorder controls.

Identifiants

DOI: 10.1016/j.jtha.2024.09.037 PMID: 39454883
pubmed: 39454883
pii: S1538-7836(24)00627-5
doi: 10.1016/j.jtha.2024.09.037
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Investigateurs

Elisabeth Ambrose (E)
Mercy Charles (M)
Jovana Despot (J)
Ryan Duggan (R)
Lydia Elbatarny (L)
Tegan Evans (T)
Alexandra Garven (A)
Julie Grabell (J)
Dana Ivanco (D)
Anne Marie Lauf (AM)
Zhiying Liang (Z)
Karen Panckeri (K)
Sarah Rubinstein (S)
Rebecca Sampat (R)
Krystina Stutely (K)
Vidushi Swarup (V)
Romina Tahmasebi (R)
Grace Tang (G)
Ming Yang (M)

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

Auteurs

Leslie Skeith (L)

Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada. Electronic address: laskeith@ucalgary.ca.

Paula James (P)

Department of Medicine, Queen's University, Kingston, Ontario, Canada.

Peter Kouides (P)

Mary M. Gooley Hemophilia Centre, Rochester, New York, USA.

Kelsey Uminski (K)

Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Alberta, Canada; Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Lisa Duffett (L)

Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Shannon Jackson (S)

Division of Hematology, Department of Medicine, University of British Columbia Vancouver, British Columbia, Canada.

Michelle Sholzberg (M)

Departments of Medicine, and Laboratory Medicine and Pathobiology, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.

Margaret V Ragni (MV)

Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center, and Hemophilia Center of Western PA, Pittsburgh, Pennsylvania, USA.

Adam Cuker (A)

Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Maeve O'Beirne (M)

Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.

Julia Hews-Girard (J)

Department of Community Health Sciences, University of Calgary, Alberta, Canada; Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.

Natalia Rydz (N)

Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Alberta, Canada.

Dawn M Goodyear (DM)

Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Alberta, Canada.

Jill Baxter (J)

Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.

Andra James (A)

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.

David Garcia (D)

Department of Medicine, University of Washington School of Medicine, Seattle.

Sara K Vesely (SK)

Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

Man-Chiu Poon (MC)

Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Alberta, Canada; Arnie Charbonneau Cancer Institute, University of Calgary, Alberta, Canada.

Classifications MeSH