70% greater risk of bleeding after childbirth found for women with VWD
US claims data also show longer hospital stays for those with bleeding disorder
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Women with von Willebrand disease (VWD) in the U.S. are 70% more likely to experience heavy bleeding after childbirth, known as postpartum hemorrhage, than those without the condition, which is marked by the body’s inability to properly form blood clots.
That’s according to a nationwide claims analysis, conducted by researchers in Pennsylvania, that also found that women with VWD — the most common inherited bleeding disorder — had longer hospital stays after giving birth. Emergency department visits or readmissions within 30 days of delivery were also more likely for new mothers with VWD.
“Overall, this study shows that postpartum [post-childbirth] bleeding remains an important and ongoing issue for women with von Willebrand disease” in the U.S., the researchers wrote. But even with this new analysis of insurance claims data, “there is still limited information about what happens in real-world delivery care across the United States,” the team wrote.
The scientists said that “prospective studies incorporating laboratory and clinical data are needed” to give a fuller picture.
“[More] details are needed to better understand which patients are at highest risk and how to improve the prevention of postpartum haemorrhage,” the team wrote.
The study, “Risk of Postpartum Hemorrhage in Women With Von Willebrand Disease: A Real-World Data Analysis,” was published in the journal Haemophilia by a quintet of researchers from the University of Pittsburgh Medical Center.
A rare condition, VWD is caused by defects in von Willebrand factor (VWF), a protein that helps blood clot. Its symptoms can be similar to those of hemophilia, another bleeding disorder, though they’re typically less severe.
Because childbirth places substantial demands on the body’s processes for stopping bleeding, women with VWD may experience complications after having a baby. These include postpartum hemorrhage (PPH), or heavy bleeding after delivery.
Researchers culled data from nearly 1.5 million US deliveries
U.S. data on maternal outcomes and real-world treatment patterns in women with VWD remain limited, however.
To address this gap, the research team conducted a retrospective study using 11 years of data from the FAIR Health National Claims Database, a large repository of de-identified U.S. commercial insurance claims.
“We aimed to quantify associations with PPH, length of stay, 30-day healthcare utilization, and in-hospital mortality,” the team wrote.
Among the nearly 1.5 million deliveries identified, 1,514 (0.1%) involved claims with VWD. The data were then adjusted to account for cesarean delivery and obesity.
According to the researchers, the analysis found that claims-recorded VWD was associated with a 70% higher risk of PPH than those without the bleeding disorder.
“Women with … VWD had increased odds of PPH,” the scientists wrote.
Additionally, for those with VWD, length of stay — versus the group median — and emergency department visit or hospital readmission within 30 days of delivery were also higher. Specifically, there was a 58% increased risk of a longer hospital stay for those with the bleeding condition, as well as a 20% greater likelihood of requiring readmission or an emergency visit. In-hospital death, however, was not significantly linked with VWD.
Women with … VWD had increased odds of [postpartum hemorrhage, or heavy bleeding after childbirth].
For those without cesarean delivery or obesity, the likelihood of PPH was nearly double in women with VWD than without (6.36% vs. 3.84%). Similar results were found for length of stay above the group median (20.16% vs. 13.76%) and emergency department visit or hospital readmission (7.1% vs. 5.98%).
Regarding treatment, women with VWD who received VWF replacement therapy were more than three times more likely to experience heavy bleeding after delivery than women not taking this therapy. In comparison, claims for desmopressin, a medication that boosts VWF, were similar.
The authors said that these treatment-related findings do not mean that treatment caused bleeding. Instead, “these women were treated because they were already considered to be at higher risk, had more severe disease, were actively bleeding, or raised greater concern for their clinical team.”
Further studies needed to ‘improve maternal outcomes’
The researchers noted that women with VWD were more likely to live in geozips — geographic areas based on ZIP code — with a higher proportion of white residents and a lower proportion of Hispanic residents than women without VWD. In models adjusting for age and geozip racial and ethnic composition, VWD remained linked to 71% higher odds of PPH.
A lower white population proportion in a geozip was defined as less than 25%, compared with a reference group of more than 75%. This was associated with 11% lower odds of PPH but 2.67 times higher odds of longer hospital stay.
Differences in Black population proportion by geozip were less pronounced between groups, and geozip-level Asian population proportion was low across the entire group, the data showed.
The team said the findings on these community-level variables “should be interpreted as exploratory and hypothesis-generating,” and not reflective of race- or ethnicity-based effects.
Among this study’s limitations, the authors noted missing data, including VWF levels, VWD subtype, bleeding scores, and response to desmopressin. Timing, dosing, and treatment indication were also unavailable.
“Women with claims-recorded VWD had increased odds of PPH and greater peripartum healthcare utilization in this national claims cohort,” the researchers concluded. “Future prospective United States studies … are needed to refine peripartum risk stratification and improve maternal outcomes.”
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