ABSTRACT
BACKGROUND: Clinical guidelines for postpartum thromboprophylaxis differ due its uncertain effect and varying preferences of experts. Women's preferences for postpartum thromboprophylaxis are unknown, although they may inform practices and future research. Our aim was to elicit the pregnant women's preferences for postpartum thromboprophylaxis, according to different risks of venous thromboembolism (VTE) and bleeding. METHODS: In two Swiss and French maternity hospitals, we conducted structured interviews of pregnant or postpartum women. Participants were instructed on pulmonary embolism (PE), deep vein thrombosis (DVT), postpartum hemorrhage (PPH) and subcutaneous injections of low-molecular-weight heparin (LMWH). First, we randomized women to either standard gamble or time trade-off (two different validated methods) to estimate the utilities (quality-of-life, from 0-1) of these health states. Second, we elicited the preference for the use of short-term postpartum thromboprophylaxis with LMWH vs. none across different risks of postpartum VTE and bleeding, through direct-choice exercises. RESULTS: Among 122 participants, median (IQR) health states utilities were 0.725 (0.30-0.925) for PE, 0.75 (0.40-0.97) for PPH, 0.85 (0.60-0.97) for DVT and 0.96 (0.96-0.999) for LMWH injections. The median risk of postpartum VTE to prefer the use of postpartum thromboprophylaxis over no treatment was 0.1% (IQR 0.01-0.50%) without LMWH-associated bleeding risk and 0.2% (IQR 0.1-5%) with a 1% bleeding risk. CONCLUSIONS: European pregnant women appear to have a high willingness for 10-day postpartum thromboprophylaxis, preferred over no treatment even for low risks of postpartum VTE. This perspective from patients supports the urgent need for a randomized trial evaluating the efficacy and safety of postpartum thromboprophylaxis.
ABSTRACT
One in five pregnant women has obesity in Europe. It is an independent risk factor for maternal and foetal complications during pregnancy and delivery, increasing linearly with pre-conceptional body mass index. Excessive gestational weight gain further aggravates these risks. The clinician should measure body weight at each visit from the 1st trimester of pregnancy, search and monitor complications and be aware of preventive measures. A balanced diet with low glycemic load and light to moderate physical activity 3060 minutes 35 times per week should be recommended during pregnancy and postpartum to control gestational weight gain and reduce the risks of short and long-term maternal and infant complications.
L'obésité touche une femme enceinte sur cinq en Europe, ce qui constitue un facteur de risque indépendant de complications maternelles et fÅtales pendant la grossesse et l'accouchement, et augmente de manière linéaire avec l'indice de masse corporelle préconceptionnel. Une prise de poids excessive pendant la grossesse aggrave ce risque initial. Le clinicien devrait mesurer le poids maternel à chaque visite dès le 1er trimestre, ainsi que rechercher et surveiller les complications et connaître les mesures de prévention. Une alimentation équilibrée à index glycémique bas et une activité physique légère à modérée 3060 minutes, 35 fois par semaine, doivent être encouragées pendant la grossesse et le postpartum afin de contrôler la prise pondérale et réduire les risques de complications maternelles et infantiles à court et à long termes.
