(811) Severe Neonatal Morbidity Among Jehovah’s Witnesses and Others Declining Blood Products

Objective:
To evaluate the incidence of severe neonatal morbidity (SNM) among Jehovah’s Witnesses and other patients who decline blood products compared to the general obstetric population. These patients may be at increased risk for adverse neonatal outcomes due to deviations from routine obstetric management.

Study Design:
This retrospective cross-sectional study included all deliveries at two regional perinatal centers in a large New York health system from 2019-2024. Exclusion criteria were fetal demise and multiple gestation. The primary exposure was blood product refusal, documented at admission via a standardized intake question for all patients. The primary outcome was SNM, a composite neonatal adverse outcome indicator which includes diagnoses and procedures that signify life-threatening neonatal complications. Multivariable logistic regression modeled the association between blood product refusal and SNM, adjusting for race and ethnicity group, public health insurance, multiparity, obstetric comorbidity index (OB-CMI) score, gestational age at delivery, fetal growth restriction, and newborn sex. SNM is strongly influenced by gestational age; as nearly all deliveries before 32 weeks have some form of SNM, analysis was restricted to deliveries at ≥32 weeks with gestational age included as a covariate.

Results:
A total of 78,899 pregnancies were included. Blood product refusal was documented in 589 cases. Non-Hispanic White patients constituted the largest race and ethnicity group (42.6%), followed by Asian or Pacific Islander (19.3%), Non-Hispanic Black (14.0%), and Hispanic patients (12.6%). SNM occurred in 8.3% of patients declining blood products compared to 6.7% in the general obstetric population which was not a statistically significant difference (aOR 1.06; 95% CI 0.76-1.45; p=0.71). 

Conclusion:
There was no difference in SNM between patients who declined blood products and the general obstetric population. Further research is needed to assess potential neonatal risks and inform management in this population.