Venous thromboembolism in pregnancy and postpartum among women with physical disabilities

To compare the incidence of venous thromboembolism (VTE) in pregnant and postpartum people with and without a physical disability. This was a population-based cohort study of 15 to 49-year-olds who gave birth in Ontario, Canada, 2007-17. Physical disabilities were conditions likely to result in restricted mobility (e.g., cerebral palsy, hemi/paraplegia, multiple sclerosis, muscular dystrophy, poliomyelitis sequelae, spina bifida, spinal cord injury) diagnosed before conception. We used modified Poisson regression to compare the occurrence of VTE in pregnancy and the first 6 weeks postpartum in people with and without a physical disability. Models were adjusted for demographics, thrombophilias, and other comorbidities. In additional analyses, we compared the occurrence of perinatal VTE in people with a physical disability who used a mobility aid to those with a physical disability who did not use a mobility aid, and to people without a physical disability. In a subcohort of people receiving publicly-funded drug benefits, we also compared the frequency of perinatal VTE prophylaxis in people with and without a physical disability. Of 1,220,822 individuals (13,791, or 1.1% with physical disability), VTE occurred in 2.2% of those with a physical disability versus 1.2% of those without (aRR 1.56, 95% CI 1.39-1.76, Table 1). Risk for VTE was especially high among those with a physical disability who used a mobility aid, at 10.0%, compared to 1.2% in those without a physical disability (aRR 4.05, 95% CI 2.76-5.96) (Table 1). In a sub-cohort of people who received publicly-funded drug benefits, VTE prophylaxis was more common in people with a physical disability than in those without a physical disability (2.4% vs. 0.8%; aRR 2.32, 95% CI 1.68-3.21). Individuals with a physical disability, and especially those using mobility aids, are at increased risk of VTE perinatally. Prophylactic anticoagulation should be considered for this population.