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. 2021 Oct 4;11(10):e050815.
doi: 10.1136/bmjopen-2021-050815.

Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: a prospective cohort study

Manisha Nair  1 , Shakuntala Chhabra #  2 , Saswati Sanyal Choudhury #  3 , Dipika Deka #  4 , Gitanjali Deka #  5 , Swapna D Kakoty #  6 , Pramod Kumar #  2 , Pranabika Mahanta #  7 , Robin Medhi #  6 , Anjali Rani #  8 , Seeresha Rao #  9 , Indrani Roy #  10 , Carolin Solomi V #  11 , Ratna Kanta Talukdar #  7 , Farzana Zahir #  12 , Nimmi Kansal  13 , Anil Arora  13 , Charles Opondo  14 , Jane Armitage  14 , Michael Laffan  15 , Simon Stanworth  16 , Maria Quigley  17 , Colin Baigent  14 , Marian Knight  17 , Jennifer J Kurinczuk  17 ; MaatHRI collaborators
Affiliations

Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: a prospective cohort study

Manisha Nair et al. BMJ Open. .

Abstract

Objectives: To investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7-9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth.

Design: A prospective cohort study of pregnant women recruited in the third trimester and followed-up after childbirth.

Setting: Ten hospitals across four states in India.

Participants: 1342 pregnant women.

Intervention: Not applicable.

Methods: Hb and coagulation parameters: fibrinogen, D-dimer, D-dimer/fibrinogen ratio, platelets and international normalised ratio (INR) were measured at baseline. Participants were followed-up to measure blood loss within 2 hours after childbirth and PPH was defined based on blood loss and clinical assessment. Associations between coagulation parameters, Hb, anaemia and PPH were examined using multivariable logistic regression models.

Outcomes measures: Adjusted OR with 95% CI.

Results: In women with severe anaemia during the third trimester, the D-dimer was 27% higher, mean fibrinogen 117 mg/dL lower, D-dimer/fibrinogen ratio 69% higher and INR 12% higher compared with women with no/mild anaemia. Mean platelets in severe anaemia was 37.8×109/L lower compared with women with moderate anaemia. Similar relationships with smaller effect sizes were identified for women with moderate anaemia compared with women with no/mild anaemia. Low Hb and high INR at third trimester of pregnancy independently increased the odds of PPH at childbirth, but the other coagulation parameters were not found to be significantly associated with PPH.

Conclusion: Altered blood coagulation profile in pregnant women with severe anaemia could be a risk factor for PPH and requires further evaluation.

Keywords: anaemia; epidemiology; obstetrics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Inverted J-shaped association between Hb and platelets. Hb, haemoglobin.
Figure 2
Figure 2
Relative difference in D-dimer across the categories of anaemia.
Figure 3
Figure 3
Absolute difference in fibrinogen across the categories of anaemia.
Figure 4
Figure 4
Relative difference in D-dimer/fibrinogen ratio across the categories of anaemia.
Figure 5
Figure 5
Absolute difference in platelets across the categories of anaemia.
Figure 6
Figure 6
Relative difference in INR across the categories of anaemia. INR, international normalised ratio.
See this image and copyright information in PMC

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