Drops seen in some pregnancy, delivery complications in VWD
Prebirth bleeding rates show decline since 2000, but gaps in care remain
Although more people with von Willebrand disease (VWD) have given birth over the past two decades, the rates of certain complications, such as prebirth bleeding, have decreased significantly, a new study reports.
Still, the researchers noted that pregnancy and delivery continue to pose several risks for people with VWD. Moreover, the rates of other complications, like postpartum bleeding, have remained unchanged since 2000, the data showed.
The team hypothesized that the reductions in some of these risks over time may simply reflect more consistent clinical guidance about managing the bleeding disorder during pregnancy and childbirth.
“Declining transfusion and [prebirth bleeding] rates suggest improvements in diagnosis and management of VWD during pregnancy,” the researchers wrote, adding, however, that “stable rates of postpartum [bleeding] … highlight continued gaps in care.”
Overall, according to the team, all U.S. researchers, these findings can help “inform preconception counseling and [childbirth] planning for individuals with VWD.”
The study, “Contemporary trends in maternal outcomes during delivery hospitalizations among pregnancies complicated by von Willebrand Disease — a cross-sectional analysis,” was published in the journal Research and Practice in Thrombosis and Haemostasis.
VWD is a bleeding disorder caused by a lack of functional von Willebrand factor (VWF), a protein that helps the body form clots after an injury. This deficiency in VWF puts people with the condition at risk of experiencing abnormal bleeding.
VWD is risk factor for bleeding in pregnancy, delivery among patients
Like other bleeding disorders, VWD is a risk factor for excessive bleeding during pregnancy and delivery. Because of this, several clinical societies have developed guidelines for caring for pregnant women with VWD.
Nonetheless, “the real-world impact of the multidisciplinary care models and clinical management guidelines that have been introduced to optimize outcomes in this high-risk patient population remains unclear,” the team wrote.
To learn more about pregnancy and delivery complications in people with VWD, and how such issues have evolved in recent years, the researchers examined hospital insurance claims from the U.S. National Inpatient Sample database. Between 2000 and 2022, the team identified more than 87 million hospital stays related to delivery for pregnant patients. In this group, the researchers then estimated the prevalence of VWD and pregnancy-related complications.
Over these two decades, the maternal prevalence of VWD increased from 2.1 to 5.1 cases per 10,000, the data showed. VWD was more commonly seen in non-Hispanic white women and among those who had a high income and were privately insured.
“These patterns may reflect disparities in access to diagnostic evaluation and care, rather than true differences in disease prevalence,” the researchers wrote.
Compared with people without VWD, those with the disease had a greater risk of experiencing several complications. Importantly, one such complication was a five times higher chance of requiring a blood transfusion, which occurred in 4.6% of people with VWD and in 1% of those without the disease.
The risk of prebirth bleeding or separation of the placenta from the uterus wall was nearly two times higher among those with VWD, with these complications occurring in 2.5% of people with the disease and in 1.4% of those without it. Similarly, the risk and rate of postpartum bleeding were also higher among women with VWD.
However, over time, rates of prebirth bleeding or placental separation decreased significantly in VWD cases, with an annual percentage drop of 9%. Rates of blood transfusions also declined significantly by 5.2% each year.
“The observed declines in transfusions and [prebirth bleeding] may reflect the impact of guideline-based, multidisciplinary management,” the researchers wrote.
Claims database used in analysis had some data gaps
Similar factors may have contributed to changes in delivery methods over time. Specifically, rates of operative vaginal delivery, in which clinicians use instruments like forceps or vacuums to assist in vaginal delivery, decreased significantly over time. Recent guidelines suggest caution when using these types of methods in VWD delivery.
However, rates of postpartum bleeding didn’t change significantly over the course of the study, the researchers noted.
“The increasing prevalence of VWD among delivery hospitalizations and decreasing rates of hemorrhage-related complications is likely a reflection of improvements in identification and management of patients with VWD,” the team wrote.
According to the researchers, the findings of sustained higher rates of postpartum hemorrhage and other maternal complications suggest people with VWD still face additional risks during pregnancy.
The increasing prevalence of VWD among delivery hospitalizations and decreasing rates of hemorrhage-related complications is likely a reflection of improvements in identification and management of patients with VWD.
While the national insurance claims database allowed researchers to analyze a large population, it also posed some limitations. For example, insurance claims didn’t consistently include information about VWD type.
It is possible that increasing VWD rates are related to more consistent recognition of less severe types of the disease. Therefore, decreasing risks might be related to changes in patient characteristics in addition to, or instead, of clinical management.
“Future research … should focus on examining differential outcomes in VWD subtypes,” the researchers wrote.
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