Pregnancy in patients with sickle cell disease: maternal and perinatal outcomes

Abstract

Objective: To compare obstetrical, hematological and neonatal outcomes of pregnant women with or without sickle cell disease (SCD).

Methods: A prospective study of 60 pregnancies of 58 women with SCD (29 SCD-SS and 29 SCD-SC) compared with 192 pregnancies in 187 healthy pregnant women was carried out from January 2009 to August 2011.

Results: Compared to controls, the SCD group had higher rate of preterm delivery (p < 0.001, OR = 4.96, 95% CI 2.57–9.59), higher cesarean rate (p < 0.001, OR = 5.00, CI 2.65–9.45), more frequent deep vein thrombosis (p = 0.003), and urinary infection (p = 0.001, OR = 3.31, CI 1.63–6.73), higher prevalence of small for gestational age babies (p = 0.019, OR = 2.66, CI 1.15–6.17), and more frequent baby admissions to progressive care unit (p < 0.001, OR = 4.89, CI 2.26–10.6). Maternal death rate was also higher among women with SCD (p = 0.056). All adverse events were more frequent in the SS subgroup. Babies from the SS subgroup had the lowest weight at birth (2080 g) compared to SC (2737 g; p < 0.001) and controls (3035 g). A multivariate analysis confirmed painful episodes and SS genotype as factors contributing to preterm delivery.

Conclusion: SCD pregnant women – especially those in the SS subgroup – are more prone to experience perinatal and maternal complications in comparison with pregnant women without SCD.

• Acute chest syndrome
• albuminuria
• hemoglobin SC
• preterm delivery
• sickle cell anemia

Acknowlegements

Our thanks to all members of Project Aninha, in special to Milza Januario, MD, José Nelio Januario, MD, and Patricia Resende Cardoso, MD; to English translator Kelen Lima, and to Professor Kwaku Ohene-Frempong for his kind revision of the article.

Declaration of interest

This study was financially supported by the Ministry of Health, Project Aninha. The authors report no conflicts of interest.