Venous thromboembolism in pregnancy: recent advances

Abstract

Venous thromboembolism (VTE) is notably more common in pregnancy, with at least a 5‑fold higher risk than in nonpregnant women, and an even greater surge postpartum. Pregnancy induces a hypercoagulable state with venous stasis and vascular changes, making VTE a leading cause of maternal morbidity and mortality, particularly in the postpartum period. Clinical presentation is often subtle or nonspecific, highlighting the need for objective diagnostic strategies adapted to pregnancy. Emerging diagnostic algorithms, including D‑dimer-guided approaches and pregnancy‑specific rules, such as the pregnancy‑adapted YEARS criteria, are improving diagnostic accuracy while limiting unnecessary imaging. Prevention and treatment regimens are tailored to pregnant patients, with low‑molecular‑weight heparin remaining the cornerstone of therapy. Ongoing research is exploring individualized prophylaxis based on personal risk profiles, biomarker‑driven risk stratification, and optimized postpartum management protocols. Under‑recognized issues, such as superficial vein thrombosis and rare but high‑risk thrombophilias (eg, antithrombin deficiency) are also garnering attention for their contribution to pregnancy‑associated VTE risk. This review provides a comprehensive update on pregnancy‑related VTE, highlighting evolving concepts in epidemiology, diagnosis, prevention, and management of deep and superficial venous thromboses and pulmonary embolism from pregnancy through the postpartum period.