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Incidence and Risk Factors for Pregnancy-Associated Venous Thromboembolism: Are There Differences between East and West?Funding This work was supported in part by grants from the Ministry of Science and Technology (MOST 107-2314-B-075-062-MY3, MOST 110-2314-B-075-059, MOST 111-2314-B-075-004-MY2), Taipei Veterans General Hospital (V108B-015, V108B-027, V108C-090, V109C-042, V109C-186, V110C-132, V110C-138, V110B-035, V111C-020, V111B-035, V112C-019, V112B-002, V11B-006), Research Foundation of Cardiovascular Medicine, and Szu-Yuan Research Foundation of Internal Medicine, Taipei, Taiwan.
Venous thromboembolism (VTE) manifests as thrombus formation in deep vein usually in lower legs which subsequently embolizes to pulmonary artery causing pulmonary embolism and increased risk of morbidity and mortality. Even in this journal there has been much interest in the epidemiology, prognosis, and risk factors for VTE, as well as the pathophysiological mechanisms underlying the propensity to develop this common condition.     
Pregnancy is an important risk factor for VTE. Several previous studies reported the incidence of pregnancy-associated VTE (PA-VTE) for Western population.    One population-based cohort study of Canadian Institute for Health Information showed that the incidence rate of PA-VTE was 12.1 cases of per 10,000 deliveries between year 1991 and 2006. Another Denmark population registry revealed an incidence rate of 5 cases per 10,000 deliveries from year 1995 to 2005. As for United States, the incidence rate of PA-VTE was 6.6 per 10,000 deliveries between year 2000 and 2018, which increased from 4 per 10,000 deliveries (from year 1978 to 1996). These studies were carried out in different populations using different databases with different timelines. Therefore, it may be difficult to clearly understand the time trends of the incidence of PA-VTE.
Data from South Korea provided important information about the incidence and time trend of PA-VTE for Asians.  In the study by Jang et al, utilizing the Korean Health Insurance Review and Assessment Service database, they reported the incidence rate of PA-VTE as 0.82 case per 10,000 deliveries in the Korean population from year 2004 to 2008. In this issue of Thrombosis and Haemostasis, Hwang and colleagues used the similar database and reported the incidence rate of PA-VTE as 2.62% per 10,000 deliveries during year 2014 to 2018 in the Korean population. The incidence rate of the second study increased approximately 3.2 times higher than that in the first study. Since these two studies were based on the same dataset, increasing incidences of PA-VTE in the Korean population were well illustrated ([Fig. 1]). Furthermore, like overall VTE, the risk of PA-VTE was also higher for Asian population compared to non-Asians ([Fig. 1]).
The trends about the increasing risk of PA-VTE may be related to more pregnancy in advanced maternal age in modern society and the recent progress in assisted reproductive technology to treat infertility resulting in two- to threefold increased risk of VTE compared to spontaneous pregnancy. Reported risk factors for PA-VTE included multiparity, multifetal pregnancies, advancing maternal age, cesarean section, cardiac disease, delivery at gestational age of <36 weeks, a body mass index of ≥25, or more, and postpartum period.   These risk factors were not obviously different between Western and Eastern population ([Fig. 1]). An underlying hormonal pathophysiological basis is possible, given the well-recognized links of VTE to oral contraceptive pills.
Despite a lower risk of PA-VTE in Asians, the risk is increasing. Obstetricians need to be aware of the risks of VTE especially for patients with clinical high-risk features. Indeed, a focus has been directed on patient and health care provider-reported outcomes to gleam more information on this condition.
Received: 24 April 2023
Accepted: 24 April 2023
Article published online:
05 June 2023
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