Race/Ethnicity as a Risk Factor in the Development of Postpartum Hemorrhage: A Thorough Systematic Review of Disparity in the Relationship Between Pregnancy and the Rate of Postpartum Hemorrhage

Abstract

Postpartum hemorrhage (PPH) is a major cause of maternal death and morbidity worldwide. Throughout the years, there have not been many studies looking into the association of race and ethnicity with the occurrence of PPH. The goal of this study was to assess race and ethnicity as risk factors in the development of PPH in pregnant women. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) standards, we conducted the analysis and conducted a literature search using Google Scholar and PubMed. After applying our inclusion and exclusion criteria, the search technique yielded a total of eight articles. The analysis included seven observational studies and one randomized controlled trial. The incidence of PPH was chosen as the major outcome measure. An evaluation of eight studies revealed that although Hispanics, Asians, Native Hawaiians, and other Pacific Islanders (NHOPI) have a higher chance of developing PPH caused by uterine atony, Caucasians had a greater rate of transfusion than the other groups. In addition, compared to Caucasians, African Americans or African descendants had a lower risk of atonic PPH but increased odds of atonic PPH requiring interventions. On the other hand, compared to non-native groups, Native Americans had increased odds of uterine atony. The results showed that, in contrast to other races/ethnicities, Caucasians had the lowest risk of PPH. Additionally, it was shown that African Americans or those descended from Africans had a higher chance of PPH but a lower risk of atonic PPH.

Sarcoidosis in pregnancy

“…study. Furthermore, this study had a higher proportion of African American women, with an associated independent increased risk of PPH 41 …”

“…Furthermore, this study had a higher proportion of African American women, with an associated independent increased risk of PPH. 41 A tendency to increased risk of fetal structural differences was seen in K€ ocher et al, with 6.1% affected compared with 3.7% in the control population, although this difference was not statistically significant when adjusted (RR 1.6; 95% CI 0.9-2.8). 37 No other increased neonatal risk has been reported.…”

Oxytocin receptor single nucleotide polymorphism predicts atony-related postpartum hemorrhage

“…A systematic review from 2008 noted broad global variability, with the highest rates of severe PPH (defined as 1000 mL) in Latin American countries at 5.3% of births, compared to 2.2% among African countries and 1.78% among Asian countries [ 26 ]. Some studies have documented that African American subgroups, have higher rates of PPH, but this is a less consistent finding, and one review highlighted that uterine atony related PPH was not more common among African American individuals [ 25 ]. Importantly, morbidity appears to be higher for African American individuals when PPH occurs [ 16 ], possibly related to disparities in appropriate/timely medical care—as implementation of a PPH specific standardized toolkit appears to reduce disparities in morbidity from PPH [ 27 ].…”

“…Finally, as mentioned, various demographic groups, which may have common ancestry are also associated with higher prevalence of PPH [16,23,24]. Individuals with Hispanic/Latina, Native American/ Indigenous and Asian ancestry have been identified as having elevated risks for PPH compared to European ancestral groups [24,25]. A systematic review from 2008 noted broad global variability, with the highest rates of severe PPH (defined as 1000 mL) in Latin American countries at 5.3% of births, compared to 2.2% among African countries and 1.78% among Asian countries [26].…”