Pregnancy outcomes of Jehovah’s Witnesses: case series over fifteen years in a tertiary teaching hospital

Background: More than 5000 Jehovah’s Witnesses resided in Hong Kong. Higher morbidity and mortality rates in pregnancy were associated with this specific group of women than the general population. We aim to assess the obstetric and neonatal outcomes of Jehovah’s Witnesses (JW) mothers in a teaching hospital and to evaluate the acceptance rate of blood fractions and blood transfusion alternatives. Methods: This is a retrospective case-control study. Women who delivered from 1st January 2005 to 31st December 2020 were analysed from the electronic Clinical Data Analysis and Reporting System (CDARS). Patients who identified themselves as JW were reviewed. The immediate next age-matched non-JW patient in the antenatal care booking register was recruited as control. Results: There were 83 JW women identified within the study period. 35 delivered overseas or in the private sector, leaving 48 women for analysis. 8 (16.7%) accepted blood transfusion; 11 (22.9%) accepted some minor fractions, 29 (60.4 %) refused all blood components. 42 (87.5%) had consultant review and anaesthesiologist consultation before delivery with confirmation of their advanced directives. JW mothers had similar haemoglobin levels to controls at different time points – at booking, third trimester, delivery and the postnatal period (p=0.53-0.857). Pregnant JW were more likely to receive iron supplements in the antenatal period (p=0.006) compared with age-matched control. In terms of obstetrics outcome, there was no difference in mode of delivery compared with control. 30 (62.5%) had normal vaginal deliveries, 4 (8.3 %) had instrumental births and 14 (29.1%) had Caesarean births in JW arm. There was no increase in blood loss at delivery for JW mothers (p=0.19). Neonatal outcome in terms of mean birthweight (3266 grams vs 3041 grams, p=0.188) and 5-min Apgar score (9.8 vs 9.9, p=0.448) were comparable between JW and non-JW group. There were no maternal deaths, no hysterectomy and no admissions to the adult intensive care unit in either arms. Conclusion: Pregnant JW who received optimised obstetric care had similar outcomes to controls who were non-JW. The risk of morbidity could be mitigated with precautions and JW mothers should not be discriminated on the choice of blood product refusal.