Postpartum hemoglobin module

1.0 Overview

This module exists to model hemoglobin and anemia outcomes in the postpartum period among birthing parents who survive labor and is part of the postpartum component of the simulation. Notably, postpartum hemoglobin is determined from hemoglobin at end of pregnancy (an output of the pregnancy component hemoglobin module) and whether a simulant experienced postpartum hemorrhage.

2.0 Module Diagram and Data

Follow the steps below to model the postpartum hemoglobin module. Module inputs and outputs are summarized in the tables below.

  1. Determine if simulant survived labor and progressed to the postpartum period

  2. Among surviving simulants, assign hemoglobin exposure for the first six weeks after delivery equal to hemoglobin exposure at birth

  3. Shift hemoglobin exposures for incident cases of maternal hemorrhage according to the maternal hemorrhage risk effects document effect on the first six weeks after the end of pregnancy

  4. Among surviving simulants, assign the hemoglobin exposure between 6 weeks and 9 months postpartum using the non-pregnant hemoglobin distribution (MEID 27596, GBD 2023 version mv_20250804_flash_regal_snake) and the same propensity that was used to assign the simulant their initial hemoglobin exposure.

  5. Shift hemoglobin exposures for incident cases of maternal hemorrhage according to the maternal hemorrhage risk effects document effect on the period from 6 weeks to 9 months after the end of pregnancy

Module required inputs

Input

Source module

Application

Note

Hemoglobin at end of pregnancy

Hemoglobin module

Informs hemoglobin exposure between birth and 6 weeks postpartum, and between 6 weeks and 9 months postpartum

Maternal hemorrhage incidence

Maternal disorders module

Incident maternal hemorrhage cases decrease hemoglobin exposure between birth and 6 weeks postpartum, and between 6 weeks and 9 months postpartum
Module outputs

Output

Value

Dependencies

Postpartum hemoglobin

Point value

Used for V&V of maternal hemorrhage effect on postpartum hemoglobin

3.0 Assumptions and limitations

  • We assume the pregnancy-specific hemoglobin thresholds for anemia apply to the first six weeks after the end of pregnancy

  • We apply the effect of maternal hemorrhage on hemoglobin to the first six weeks after the end of pregnancy and the period from 6 weeks to 9 months after the end of pregnancy as discrete timesteps, which does not capture the continuous nature of hemoglobin changes over time

  • We assume that the impacts of all interventions that have modified hemoglobin during pregnancy last only until six weeks after the end of pregnancy

4.0 Verification and Validation Criteria

  • Effect of maternal hemorrhage on postpartum hemoglobin (postpartum hemoglobin stratified by maternal hemorrhage incidence) should be as expected

5.0 References