Journal Article Ppublish
PubMed: 42595052 DOI: 10.1016/j.jtha.2026.07.029
Socioeconomic status and its association with venous thromboembolism during pregnancy and postpartum: results from a Dutch population-based study.
J Thromb Haemost 24(11):3989-4000
Authors: Sophie G Ten Have, Moska Nazir, Menno V Huisman, Tim I M Korevaar, Marieke J H A Kruip, Saskia Middeldorp, Annemarie G M G J Mulders, Koen Verdonk, A Titia Lely, Wilma J Nusselder, Judith Kooiman
Affiliations
- Department of Obstetrics and Gynaecology, Erasmus MC, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Department of Medicine-Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands.
- Department of Internal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Department of Haematology, Department of Quality and Patient Care, Erasmus MC, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Obstetrics and Gynaecology, Erasmus MC, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Abstract
BACKGROUND
Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality. While socioeconomic status (SES) is associated with adverse maternal and perinatal outcomes, its association with pregnancy-related VTE has not been studied.
OBJECTIVES
This study aims to quantify the association between SES and pregnancy-related VTE in the Netherlands.
METHODS
We conducted a retrospective nationwide cohort study, including all pregnancies resulting in births (>16 weeks' gestation) in 2014-2015 from the Dutch Perinatal Registry (Perined). These records were anonymously linked to healthcare and sociodemographic data from Statistics Netherlands. VTE events were identified using diagnostic and International Classification of Diseases, 10th Revision (ICD-10) codes. SES was assessed by equivalized disposable household income (quintiles) and maternal education levels (low, middle, and high). Associations were evaluated using Kaplan-Meier analyses and multivariable Cox regressions, adjusting for demographic, clinical, and obstetric factors.
RESULTS
Among the 334 828 included pregnancies, an absolute VTE risk of 0.31% (95% CI, 0.29-0.33) was observed. Compared with women in the highest income quintile (Q5) (0.22%, 95% CI, 0.18-0.26), those in the three lowest quintiles had higher VTE risks (Q1: 0.37%, 95% CI, 0.32-0.42, adjusted hazard ratio [aHR] 1.70, 95% CI, 1.33-2.18; Q2: 0.36%, 95% CI, 0.31-0.41, aHR 1.69, 95% CI, 1.33-2.15; Q3: 0.33%, 95% CI, 0.29-0.37, aHR 1.51, 95% CI, 1.20-1.90). Low and middle education levels were also associated with higher VTE risks (low: 0.42%, 95% CI, 0.35-0.48, aHR 1.83, 95% CI, 1.48-2.26; middle: 0.36%, 95% CI, 0.33-0.40, aHR 1.61, 95% CI, 1.37-1.89). Modeling both SES indicators concurrently and sensitivity analyses yielded similar results.
CONCLUSION
Low SES is associated with higher VTE risk during pregnancy and postpartum, highlighting persistent maternal health inequalities. Further research is needed to determine whether SES indicators improve VTE risk prediction and stratification in obstetric populations.
MeSH
Pregnancy, Thromboembolism, Income, Survival Analysis, Venous Thromboembolism, Thrombosis, Social Class, Education, Postpartum Period, Demography