WCM-Q research: action required to reduce risk of pulmonary embolism in pregnant and post-partum women

Weill Research by a Weill Cornell Medicine-Qatar (WCM-Q) faculty member indicates that new strategies are required to reduce the risk that women will suffer an acute pulmonary embolism (a blood clot lodged in the lung) during pregnancy or in the six weeks after childbirth.

Acute pulmonary embolism is a life-threatening condition in which an artery in the lung becomes blocked, usually by a blood clot that has formed in the legs and then become dislodged. Symptoms include shortness of breath, intense chest pain and a cough, which is sometimes streaked with blood. Pulmonary embolism often responds extremely well to treatment but in some cases can cause death.

The research examined a huge dataset of more than 37 million hospitalizations from 2007-2015 of women in the United States who were either pregnant or had recently given birth and found that some 6,333 had suffered an acute pulmonary embolism. The research also showed that mothers who suffered an acute pulmonary embolism were more likely to be Black (29.2% versus 15.0%), obese (14.9% versus 4.8%), smokers (11.0% versus 2.1%), hypertensive (10.3% versus 0.9%), had a higher prevalence of diabetes mellitus (4.1% versus 1.3%), heart failure (8.5% versus 0.1%) and thrombophilia (abnormal blood coagulation) (9.9% versus 0.4%).

Importantly, the research showed that the incidence of pulmonary embolism among pregnant and recently pregnant women did not decrease during the eight-year period of the study. Furthermore, the prevalence of the risk factors that make pulmonary embolism more common – like smoking, being obese, or having diabetes - actually increased.

The research was conducted by a team of scientists at leading institutions across the world, led by Dr. Islam Elgendy, who joined WCM-Q from Massachusetts General Hospital and Harvard Medical School, and Dr. Carl Pepine at the University of Florida. The study, titled ‘Acute pulmonary embolism during pregnancy and puerperium: National trends and in-hospital outcomes’ has been published in Mayo Clinic Proceedings, a prestigious medical journal.

Dr. Elgendy said: “Maternal mortality rates have increased in the US in recent years, unlike other developed countries, and cardiovascular diseases are now the leading causes of death. The good news is that acute pulmonary embolism in pregnancy and very early motherhood is rare. However, our analysis shows that it still affects a significant minority of women and the numbers have not fallen in the past decade. Moreover, the risk factors that we know make pulmonary embolism more likely are becoming more prevalent. All of these factors mean there is a need for new strategies to reduce the incidence of pulmonary embolism so that as many mothers as possible can have a safe pregnancy, childbirth and post-partum period with their new baby.”

The other researchers who contributed to the study are based at the College of Health and Life Sciences at Hamad Bin Khalifa University in Qatar, the Warren Alpert School of Medicine at Brown University in Providence, Rhode Island, the University of Washington in Seattle, University of Texas Medical Branch at Galveston, University of Arkansas for Medical Sciences in Little Rock, Loyola University Chicago, Beth Israel Deaconess Medical Center in Boston, Keele University in the UK, Royal Stoke University Hospital in Stoke-on-Trent, UK, Hospital Universitari Germans Trias i Pujol in Barcelona, and Cleveland Clinic in Ohio.

Dr. Khaled Machaca, Senior Associate Dean for Research, Innovations, and Commercialization at WCM-Q, said: “This excellent and timely study by Dr. Elgendy and his fellow contributors around the world demonstrates the power of big data and collaborative efforts to help us understand the most pressing health trends globally, with the ultimate aim of improving healthcare outcomes for patients, particularly those in Qatar.”

The study can be read in full here: https://www.mayoclinicproceedings.org/article/S0025-6196(21)00060-4/fulltext