This was the first study to investigate the role of coagulation in relation to the increased risk of postpartum haemorrhage (PPH) in women with moderate-severe anaemia. Previous studies in India have repeatedly shown that pregnant women with anaemia (particularly severe anaemia) are at a higher risk of PPH. This is the first study to identify a new potential role of an impaired coagulation profile in pregnant women with anaemia that could lead to PPH. The prospective cohort study found that coagulation parameters in pregnant women with moderate-severe anaemia are deranged which could lead to an increased risk of PPH; a life-threatening complication due to severe bleeding after childbirth. The role of coagulation parameters has not been studied before, so this is highly valuable scientific evidence that has the potential to prevent PPH and save the lives of thousands of mothers globally, where anaemia in pregnancy is a public health problem.
The study showed that pregnant women with moderate-severe anaemia (haemoglobin <10gm/dl) during the third trimester of pregnancy had a higher D-dimer, lower fibrinogen and therefore a higher D-dimer/fibrinogen ratio compared to those with mild or no anaemia (haemoglobin ≥10gm/dl).
Pregnant women with moderate-severe anaemia also had a higher INR compared to those with mild or no anaemia.
Having a lower haemoglobin and higher INR during the third trimester of pregnancy was independently associated with higher risk of PPH at childbirth, but we did not find any association between PPH and the other coagulation parameters.
Preventing anaemia during pregnancy has been a priority worldwide. This study further demonstrates the need to do this to prevent adverse effect of anaemia on the coagulation cascade during pregnancy. Further studies are needed including testing medicines that could normalise the coagulation cascade before childbirth in order to prevent PPH.
Funding: This study is funded by the Nuffield Department of Population Health's Pump-priming award.