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Key findings: Compared to matched controls: 12.8 higher odds of transfusion preterm birth (aOR ~1.8) No significant increase in reported PPH (recent cohort) Important nuance The lack of PPH signal doesnt mean no bleeding risk: Transfusion rates remain high Suggests bleeding + anemia (e.g., iron deficiency) may be underappreciated drivers What this tells us, even in modern care: VWD still impacts maternal outcomes Traditional endpoints (like PPH) may miss part of the picture Pre-delivery optimization (iron, hemostasis) matters as much as delivery management Clinical direction - Multidisciplinary care (Heme + MFM) - Routine iron deficiency screening - Better peripartum planning Ming Y Lim | G Bryce Christensen | George M