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Blood type association with bleeding outcomes at delivery in a large multi-center study

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Postpartum hemorrhage is a leading cause of maternal death globally. Recent studies have associated Type-O group to increased risk of bleeding. We aimed to determine if women with Type-O blood are at higher risk of PPH. This is a retrospective cohort analysis of a multi-center database included women admitted to labor and delivery from January 2015 to June 2018. All deliveries resulting in live birth were included. Association between Type-O and non Type-O were examined using chi-square test and fishers exact test. Prevalence of postpartum hemorrhage, estimated blood loss, drop in hematocrit and red blood cell transfusion were compared. The matched sample included 40,964 Type-O and the same number of no Type-O. The overall prevalence of postpartum hemorrhage was 6.4%, and there was no difference in the prevalence of PPH among Type-O compared to non Type-O (6.38% vs. 6.37% respectively; p = 0.96). There was no difference in hematocrit drop and estimated blood loss between Type-O and non Type-O in all deliveries. However, in cesarean delivery there was a significant difference in blood loss among the two groups. Finally, Type-O had 1.09-fold increased risk for transfusion compared to non Type O (95% CI 0.9–1.34). There is an association between Type-O group and risk of bleeding in women undergoing cesarean delivery. More prospective studies, taking into account coagulation profile, platelet count and tissue factors, are needed to draw a conclusion on whether ABO system can be considered a heritable risk of postpartum hemorrhage.

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This project was funded by NHLBI grant (K23HL141640).

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Correspondence to Homa K. Ahmadzia.

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The authors have no conflict of interest to disclose.All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Najeebah Bade, Homa Ahmadzia, Julia Ellis-Kahana and Richard Amdur. The first draft of the manuscript was written by Jamil Kazma and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Bade, N.A., Kazma, J.M., Amdur, R.L. et al. Blood type association with bleeding outcomes at delivery in a large multi-center study. J Thromb Thrombolysis (2019). https://doi.org/10.1007/s11239-019-02023-4

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  • ABO
  • Postpartum hemorrhage
  • Von Willebrand disease
  • Blood group