Utah study reveals high transfusion rates for pregnant women with VWD
Patients face a 12-fold higher risk of transfusions despite regular prenatal care
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Expectant mothers with von Willebrand disease (VWD) are more than 12 times more likely to require a blood transfusion during delivery than those without the condition, even when receiving consistent prenatal care. A new statewide study from Utah reveals that despite modern medical monitoring, women with this common bleeding disorder face significantly higher risks of complications, including preterm births.
The findings underscore a persistent gap in maternal safety for those living with VWD. While the study reported no maternal or infant deaths among the VWD group, the high rate of emergency interventions suggests that current management strategies may not be enough to prevent serious delivery-related events.
“These findings highlight the critical need for ongoing research into targeted interventions and health system strategies aimed at reducing these risks and improving maternal health outcomes,” researchers noted.
The study, “Pregnancy Outcomes in Women with Von Willebrand Disease: A Statewide Cohort Study,” was published in Research and Practice in Thrombosis and Haemostasis.
Understanding VWD and pregnancy risks
VWD is a bleeding disorder characterized by low levels or activity of von Willebrand factor (VWF), a protein that helps with blood clotting. As a result, the body cannot form blood clots properly, leading to heavy, prolonged bleeding.
Like other bleeding disorders, VWD is a risk factor for excessive bleeding during pregnancy and delivery. Several studies have demonstrated that even with specialized care and preventive VWF replacement therapy, a significant proportion of pregnant women with VWD still experience excessive bleeding after delivery.
To learn about pregnancy and delivery complications in women with VWD, researchers examined data from 2008 to 2020 from the Utah Population Database. The team identified 120 women with a first live birth, who were matched by the mother’s year of birth and age at delivery to 2,356 women who did not have VWD.
Most women in both groups (about 90%) were white, lived in urban areas (88%), and gave birth for the first time before age 25 (approximately 60%). A higher percentage of Hispanic women were in the control group (17.2% vs. 10%).
The vast majority started prenatal care during the first three months of pregnancy and attended at least 10 appointments before delivery.
Most women gained more than the recommended amount of weight, based on their body mass index (a measure of body fat that considers weight and height) before pregnancy. About one-third in each group gained the appropriate weight.
Comparing outcomes and transfusion rates
After adjusting for ethnicity, women with VWD were 12.8 times more likely to require a blood transfusion and 1.8 times more likely to have a preterm birth than those without the disease.
“Despite increased awareness, women with VWD continue to face a higher risk of adverse pregnancy outcomes compared to the general population,” the researchers wrote.
In both groups, no mothers died up to one year postpartum. Eleven (0.5%) infants in the control group, but none in the VWD group, died during that period.
When narrowing the analysis to women who gave birth for the first time in the 2017-2020 period, 39 with VWD matched to 769 controls, women with VWD were again significantly more likely to require a blood transfusion, by 13.9 times. In this analysis, VWD was not associated with increased bleeding risk after delivery.
“The lack of association with [bleeding after delivery] suggests other contributors, such as iron deficiency, which is common in inherited bleeding disorders (IBD) and increases transfusion risk,” the researchers wrote. These findings, and previous studies showing women with inherited bleeding disorders have iron deficiency, “highlight the need for routine iron deficiency screening in pregnant women with IBD.”
