By PPH Foundation
Postpartum haemorrhage, PPH, may occur after childbirth, but some of the factors associated with severe bleeding can develop much earlier in pregnancy. Identifying and managing conditions such as preeclampsia and gestational diabetes is therefore an important part of preparing for and preventing PPH.
Recent evidence published in The Lancet found that preeclampsia and gestational diabetes were among pregnancy-related factors moderately associated with PPH. The systematic review analysed 327 studies involving more than 847 million women, providing one of the most comprehensive assessments of PPH risk factors to date.
A separate systematic review and meta-analysis published in 2025, involving more than two million pregnancies, found that women with preeclampsia had almost twice the odds of experiencing PPH compared with women without the condition. The researchers noted, however, that differences between studies contributed to substantial heterogeneity, and the certainty of evidence was moderate.
Prof Moses Obimbo, Project Lead of the End PPH Initiative, emphasises the importance of addressing preeclampsia before delivery. “Preeclampsia is not only a hypertension issue. It is a major obstetric emergency risk factor that increases the likelihood of postpartum haemorrhage, organ failure, stillbirth, and maternal death,” he says.
The latest 2026 Lancet PPH prevention series further calls for prevention approaches that address risk factors before and around childbirth, alongside effective preparedness and treatment when bleeding occurs.
For the PPH Foundation, the evidence reinforces the need to look beyond the delivery room. Quality antenatal care, early identification of pregnancy complications, appropriate clinical management and preparedness for obstetric emergencies are all part of a wider effort to reduce preventable deaths from PPH.
PPH may happen after birth, but opportunities to reduce its impact begin much earlier in pregnancy.
Sources
- Yunas I, et al. Causes of and risk factors for postpartum haemorrhage: a systematic review and meta-analysis. The Lancet, 2025. PubMed
- Gallardo Cerna NV, Jara Huapaya NM, Aguirre Quispe W. Preeclampsia as a Risk Factor for Postpartum Hemorrhage: A Systematic Review and Meta-Analysis. Journal of Obstetrics and Gynaecology Canada, 2025. PubMed
- Gallos ID, et al. Prevention of postpartum haemorrhage: from evidence to implementation at scale. The Lancet, 2026. PubMed
- Coomarasamy A, et al. Postpartum haemorrhage: epidemiology, consequences, and missed opportunities. The Lancet, 2026. PubMed
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