Prenatal anemia and postpartum hemorrhage risk: A systematic review and meta‐analysis

Abstract

Introduction Postpartum hemorrhage (PPH) has remained the leading cause of maternal mortality. While anemia is a leading contributor to maternal morbidity, molecular, cellular and anemia‐induced hypoxia, clinical studies of the relationship between prenatal‐anemia and PPH have reported conflicting results. Therefore, our objective was to investigate the outcomes of studies on the relationships between prenatal anemia and PPH‐related mortality. Materials and Methods Electronic databases (MEDLINE, Scopus, http://clinicaltrials.gov, PROSPERO, EMBASE, and the Cochrane Central Register of Controlled Trials) were searched for studies published before August 2019. Keywords included “anemia,” “hemoglobin,” “postpartum hemorrhage,” and “postpartum bleeding.” Only studies involving the association between anemia and PPH were included in the meta‐analysis. Our primary analysis used random effects models to synthesize odds‐ratios (ORs) extracted from the studies. Heterogeneity was formally assessed with the Higgins' I2 statistics, and explored using meta‐regression and subgroup analysis. Results We found 13 eligible studies investigating the relationship between prenatal anemia and PPH. Our findings suggest that severe prenatal anemia increases PPH risk (OR = 3.54; 95% CI: 1.20, 10.4, p‐value = 0.020). There was no statistical association with mild (OR = 0.60; 95% CI: 0.31, 1.17, p‐value = 0.130), or moderate anemia (OR = 2.09; 95% CI: 0.40, 11.1, p‐value = 0.390) and the risk of PPH. Conclusion Severe prenatal anemia is an important predictive factor of adverse outcomes, warranting intensive management during pregnancy. PROSPERO Registration Number: CRD42020149184; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=149184.

Developing and Validating Nomogram to Predict Severe Postpartum Hemorrhage in Women With Placenta Previa Undergoing Cesarean Delivery: A Multicenter Retrospective Case-Control Study

“…Our nomogram includes preoperative HGB < 90 g/L, which is not a predictor in the existing models (9)(10)(11)(12). We think that may be related to the amount of RBC transfusion is one of the outcomes of SPPH and the influence of HGB concentration on coagulation function (19,20). The PB, AP, PP, number of prior CDs, and PAS in the nomogram were similar to the existing models (9)(10)(11)(12) and other research (21,22).…”

Examining international practices in the management of pregnant women with von Willebrand disease

“…Pregnancy may induce a consumptive iron deficiency, with anemia a well‐established risk factor for PPH 20 …”

“…Pregnancy may induce a consumptive iron deficiency, with anemia a well-established risk factor for PPH. 20 When surveyed, 93% advised evaluation of hemoglobin and/or iron status during pregnancy in women with VWD, often with repeat testing (66% of respondents perform assessment in the first trimester, 28.5% in second trimester, and 64.3% in third trimester). It was noted by some respondents that hemoglobin and iron status is routinely checked at their first antenatal visit and 28 weeks gestation by the local obstetric facility for all pregnant women or that assessment of iron status is restricted to those pregnant women identified to have anemia.…”

Low Maternal Serum 25‐Hydroxyvitamin D Concentration Is Associated With Postpartum Hemorrhage: A Retrospective Observational Study

“…We did not find any difference in platelet count and prothrombin time between groups. Furthermore, severe prenatal anemia was reported may increase PPH risk ( 40 ). Therefore, it is important to recommend vitamin D supplement in pregnant women to avoid antepartum anemia.…”