Modeling the Relationship between Maternal Blood Type, and Pregnancy Complications and Delivery Outcome through Moderated Mediation Analysis

Abstract

Pregnancy complications and adverse delivery outcome are of global concern, yet, their causal mechanism(s) are unknown. Although, there have been studies to expound the importance of maternal blood type in pregnancy, and to associate pregnancy complications with maternal blood type, unfortunately, only direct relationships have been assessed. This study employs antepartum and intrapartum risk scores, to give a fuller picture of the complex causal relationship between maternal blood type and pregnancy complications and delivery outcomes, through a moderated mediated relationship, and a double-mediated relationship respectively. Methods: This was a retrospective study of the maternal delivery records of Battor Catholic Hospital in the Volta region of Ghana. The antepartum, intrapartum, and neonatal variables from the maternal delivery records book were extracted and together with the maternal life status, these variables were converted into antepartum and intrapartum risk scores and pregnancy delivery outcome scores, according to the degree of their adverse effect on the life of mother and child. Pregnancy complications were converted into pregnancy complications scores, according to their prevalence and case fatality rates. Mediated and moderated mediated models, were employed in R to analyze the data. The index of moderated mediation between maternal blood type and pregnancy complications outcome was significant (effect = 0.14, BootSE = 0.04 and CI = (0.07, 0.24)) and the indirect effects (when HIPRSI = 0, effect = -0.071, BootSE = 0.02 and CI = (-0.11, -0.04)) of maternal blood type through the risk of pregnancy and delivery was also significant. The double-mediated relationship between maternal blood type and pregnancy delivery outcome was significant (effect = 0.17, se = 0.05 and p-value < 0.001). In conclusion, maternal blood type is the potential cause of pregnancy complications and adverse delivery outcome