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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 1

Category: Obstetric Quality and Safety

Poster Session 1

(228) Maternal Mortality and Severe Maternal Morbidity Among Jehovah’s Witnesses and Others Declining Blood Products

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  
Objective:
To evaluate the incidence of maternal mortality and non-transfusion severe maternal morbidity (SMM) among Jehovah’s Witnesses and other patients who decline blood products, compared to the general obstetric population.

Study Design:
This retrospective cross-sectional study included all deliveries at seven hospitals within a large New York health system from 2019-2024. There were no exclusion criteria. The primary exposure was blood product refusal, documented at admission via a standardized intake question for all patients. Outcomes were inpatient maternal mortality and non-transfusion SMM, with maternal mortality rates (MMR) calculated per 100,000 live births. Multivariable logistic regression modeled the association between blood product refusal and non-transfusion SMM, adjusting for race and ethnicity group, health insurance, preferred language, multiparity, and obstetric comorbidity index (OB-CMI) score, which is calculated based on 24 weighted comorbidity indicators identified through ICD-10 codes and clinical documentation.

Results:
A total of 160,516 pregnancies were included. Blood product refusal was documented in 1,107 cases, of which 373 identified as Jehovah’s Witnesses. There were 8 maternal deaths overall, with 1 occurring among Jehovah’s Witnesses. The MMR was 90.3 per 100,000 live births for patients declining blood products and 4.4 per 100,000 for others (risk ratio 20.6; 95% CI 2.5–169). Among Jehovah’s Witnesses specifically, the MMR was 268.1 per 100,000 (risk ratio 61.3; 95% CI 7.5–498). Non-transfusion SMM occurred in 2.4% of patients declining blood products versus 1.6% in others (aOR 1.43; 95% CI 0.95–2.07). Among Jehovah’s Witnesses, the non-transfusion SMM rate was 3.5% (aOR 1.82; 95% CI 0.98–3.07).

Conclusion:
Patients who declined blood products had over 20-fold higher maternal mortality, and Jehovah’s Witnesses had more than 60-fold higher mortality compared to the general obstetric population. Non-transfusion SMM was also higher among these groups, though not statistically significant.