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Original Article
- Obstetric Outcomes of Jehovah’s Witness Women Under Patient Blood Management: A Single-center, Propensity Score–Matched Cohort Study in Korea
- Jeong-Won Oh, Seug Yun Yoon, Jeong Jae Lee, Kyu Yeon Choi, Seong Soon Kwon
- J Prev Med Public Health. 2026;59(2):143-151. Published online January 6, 2026
- DOI: https://doi.org/10.3961/jpmph.25.596
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Abstract
Summary
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Supplementary Material - Objectives
Patient blood management (PBM) is increasingly recognized as an essential strategy in obstetric care for reducing transfusion-related risks and improving maternal safety. Jehovah’s Witness (JW) women, who categorically refuse blood transfusion, represent a unique clinical population in which to evaluate the effectiveness of PBM. This study aimed to assess obstetric outcomes of JW women compared with non-JW women at a PBM-based center in Korea.
Methods
We retrospectively reviewed delivery outcomes and PBM practices among JW women (n=205) with singleton pregnancies and non-JW women (n=601) who were matched at a 1:3 ratio using propensity scores at Soonchunhyang University Seoul Hospital between 2018 and 2023. The primary outcomes included obstetric morbidities, with particular attention to complications related to postpartum hemorrhage and the interventions used for its management.
Results
JW women were more likely to receive intravenous iron administration (7.3 vs. 2.8%, p=0.008) and had higher hemoglobin (Hb) levels during the first trimester (12.6±1.1 vs. 11.8±3.4 g/dL, p=0.012) than non-JW women. Blood loss during cesarean section and the incidence of severe postpartum anemia (Hb <7 g/dL) were lower among JW women; however, these differences did not reach statistical significance. In the hemorrhage-related high-risk subgroup, JW women were managed according to PBM protocols without transfusion, and their obstetric outcomes were comparable to those observed in non-JW women.
Conclusions
This study identified no significant differences in hemorrhage-related obstetric outcomes between JW and non-JW women at a PBM-based center. The systematic application of PBM enables safe delivery in transfusion-restricted settings and may reduce reliance on blood transfusion while maintaining maternal safety. -
SummaryKorean summary
수혈을 거부하는 여호와의 증인 산모에게 환자혈액관리(PBM) 프로토콜을 적용한 결과, 일반 산모와 비교하여 산후출혈 및 중증 빈혈 등 주요 산과적 합병증에서 유의한 차이는 관찰되지 않았으며, 이는 선제적인 철분 관리의 기여로 해석된다. 비록 대량 출혈 시에는 적용에 한계가 있으나, 이는 PBM이 종교적 특수 상황을 넘어 향후 혈액 수급 위기에 대응할 수 있는 보편적이고 안전한 산과적 대안이 될 수 있음을 시사한다.Key Message
Implementation of patient blood management (PBM) in Jehovah’s Witness women who refuse transfusion resulted in obstetric outcomes comparable to those of non-JW women, with no significant differences in postpartum hemorrhage or severe anemia. These outcomes were associated with proactive anemia management, including intravenous iron therapy. Although its applicability may be limited in cases of massive hemorrhage, PBM represents a safe and potentially generalizable obstetric strategy to mitigate future blood supply constraints.
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