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Editorial
. 2023 Dec 1;139(6):734-745.
doi: 10.1097/ALN.0000000000004743.

Association of Labor Neuraxial Analgesia with Maternal Blood Transfusion

Jean Guglielminotti  1 , Ruth Landau  1 , Jamie Daw  2 , Alexander M Friedman  3 , Guohua Li  4
Affiliations
Editorial

Association of Labor Neuraxial Analgesia with Maternal Blood Transfusion

Jean Guglielminotti et al. Anesthesiology. .

Abstract

Background: Labor neuraxial analgesia may reduce the odds of postpartum hemorrhage, the leading indication for maternal blood transfusion during childbirth. This study tested the hypothesis that labor neuraxial analgesia is associated with reduced odds of maternal blood transfusion overall.

Methods: U.S. birth certificate data in the Natality File of the National Vital Statistics System for all 50 states from 2015 to 2018 for vaginal and intrapartum cesarean deliveries were analyzed. The exposure was labor neuraxial analgesia. The primary outcome was maternal blood transfusion, recorded on the birth certificate, which has low sensitivity for this outcome. Adjusted odds ratios and 95% CIs of blood transfusion associated with neuraxial analgesia were estimated using propensity score matching. The adjusted odds ratios were estimated overall and according to delivery mode, and treatment effect was compared between vaginal and intrapartum cesarean deliveries using an interaction term. Sensitivity analyses were performed using inverse propensity score weighting and quantitative bias analysis for outcome misclassification.

Results: Of the 12,503,042 deliveries analyzed, 9,479,291 (75.82%) were with neuraxial analgesia, and 42,485 (0.34%) involved maternal blood transfusion. After propensity score matching, the incidence of blood transfusion was 0.30% in women without neuraxial analgesia (7,907 of 2,589,493) and 0.20% in women with neuraxial analgesia (5,225 of 2,589,493), yielding an adjusted odds ratio of 0.87 (95% CI, 0.82 to 0.91) overall. For intrapartum cesarean deliveries, the adjusted odds ratio was 0.55 (95% CI, 0.48 to 0.64), and for vaginal deliveries it was 0.93 (95% CI,. 0.88 to 0.98; P value for the interaction term < 0.001). The results were consistent in the sensitivity analyses, although the quantitative bias analysis demonstrated wide variation in potential effect size point estimates.

Conclusions: Labor neuraxial analgesia may be associated with reduced odds of maternal blood transfusion in intrapartum cesarean deliveries and, to a lesser extent, vaginal deliveries. The specific effect size varies widely by delivery mode and is unclear given the poor sensitivity of the data set for the maternal transfusion primary outcome.

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Conflict of interest statement

Conflicts of Interest:

- Jean Guglielminotti is supported by grants from the National Institute on Minority Health and Health Disparities (R01 MD018410, R21 MD016414) and from the National Institute of Mental Health (R21 MH126096), National Institutes of Health.

- Alexander Friedman is supported by grant from the National Institute of Child Health and Human Development (R01 HD104943) not related to the study and has served on an advisory board for Sage and Biogen.

- Ruth Landau was a consultant for Pacira Pharmaceuticals Incorporated and serves on the editorial board of the journal Regional Anesthesia and Pain Medicine.

Figures

Figure 1:
Figure 1:
Flowchart of the study. (a) Reasons for exclusion are not mutually exclusive.
See this image and copyright information in PMC

Comment in

Comment on

References

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