Bleeding events and other complications during pregnancy and childbirth in women with von Willebrand disease

Abstract

Background: Case reports and case series suggest that women with von Willebrand disease (VWD) are at an increased risk of bleeding complications during pregnancy and delivery. Objectives: To estimate the incidence of bleeding events and other complications in women with VWD during pregnancy and childbirth. Methods: The United States Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 2000-2003 was queried for all pregnancy-related discharges. Women with a diagnosis of VWD were compared with women without VWD. Data were analyzed based on the NIS sampling design. Logistic regression was used to compute odds ratios with 95% CI. Results: There were 4067 deliveries among women with VWD (1 in 4000 deliveries). Although women with VWD were more likely to experience antepartum bleeding [odds ratio (OR) 10.2, 95% CI: 7.1, 14.6], they were no more likely to experience premature labor, placental abruption, fetal growth restriction or intrauterine fetal demise. Women with VWD were more likely to experience a postpartum hemorrhage (OR, 1.5; 95% CI: 1.1, 2.0), and had a 5-fold increased risk of being transfused (OR, 4.7; 95% CI: 3.2, 7.0). Five of the 4067 women with VWD died, a maternal mortality rate 10 times higher than that for other women. Conclusions: Although women with VWD do not appear to be at an increased risk of poor fetal outcomes, they are at an increased risk of bleeding events and possibly death during pregnancy and childbirth. © 2007 International Society on Thrombosis and Haemostasis.