Advertisement

Contemporary outcomes of sickle cell disease in pregnancy

      Background

      Data regarding pregnancy outcomes in sickle cell disease are conflicting. Previous studies are limited by small sample size, narrow geographic area, and a wide range of resource availability.

      Objective

      The purpose of this study was to examine the association between maternal sickle cell disease and adverse pregnancy outcomes in a contemporary North American cohort.

      Study Design

      We performed a retrospective cohort study of 2,027,323 women with singleton pregnancies delivered in California from 2005–2008. Deliveries at <24 or >42 6/7 weeks of gestation were excluded. Women with sickle cell disease were compared with control subjects. Maternal outcomes of interest included preeclampsia, preterm delivery, placental abruption, oligohydramnios, and cesarean delivery; neonatal outcomes included small for gestational age, anomalies, stillbirth, neonatal death, and infant death.

      Results

      The prevalence of sickle cell disease was 0.017%. Compared with control subjects, women with sickle cell disease were more likely to have limited prenatal care (7.4 vs 3.8%; P=.001), underlying chronic hypertension (2.3% vs 1.1%; P=.038), and fetal anomalies (14.0 vs 6.4%; P<.001). The increased odds of fetal anomalies persisted after adjustment for multiple confounders (odds ratio, 1.73; 95% confidence interval, 1.26–2.38). Women with sickle cell disease also had higher odds of severe preeclampsia (odds ratio, 3.75; 95% confidence interval, 2.21–6.38), preterm delivery (odds ratio, 2.50; 95% confidence interval, 1.93–3.21), small for gestational age (odds ratio, 1.96; 95% confidence interval, 1.18–3.25), and cesarean delivery (odds ratio, 1.93; 95% confidence interval, 1.40–2.67).

      Conclusion

      Women with sickle cell disease are at high risk of maternal and neonatal morbidity. Low rates of fetal and neonatal death may reflect improved antenatal surveillance and management as compared with previous studies. The association between sickle cell disease and fetal anomalies warrants further investigation.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Stuart M.J.
        • Nagel R.L.
        Sickle-cell disease.
        Lancet. 2004; 364: 1343-1360
      1. Centers for Disease Control and Prevention. Sickle Cell Disease (SCD): Data & Statistics. 2015 7/8/2015 2/11/16]; Available from: http://www.cdc.gov/ncbddd/sicklecell/data.html. Accessed February 22, 2016.

        • Hassell K.L.
        Population estimates of sickle cell disease in the U.S.
        Am J Prev Med. 2010; 38: S512-S521
        • Boulet S.L.
        • Okoroh E.M.
        • Azonobi I.
        • Grant A.
        • Craig Hooper W.
        Sickle cell disease in pregnancy: maternal complications in a Medicaid-enrolled population.
        Matern Child Health J. 2013; 17: 200-207
        • Villers M.S.
        • Jamison M.G.
        • De Castro L.M.
        • James A.H.
        Morbidity associated with sickle cell disease in pregnancy.
        Am J Obstet Gynecol. 2008; 199: 125.e1-125.e5
        • Smith J.A.
        • Okoroh E.M.
        • Azonobi I.
        • Grant A.
        • Craig Hooper W.
        Pregnancy in sickle cell disease: experience of the Cooperative Study of Sickle Cell Disease.
        Obstet Gynecol. 1996; 87: 199-204
        • Boafor T.K.
        • Olayemi E.
        • Galadanci N.
        • et al.
        Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis.
        BJOG. 2016; 123: 691-698
        • Alayed N.
        • Kezouh A.
        • Oddy L.
        • Abenhaim H.A.
        Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births.
        J Perinat Med. 2014; 42: 487-492
        • Odum C.U.
        • Anorlu R.I.
        • Dim S.I.
        • Oyekan T.O.
        Pregnancy outcome in HbSS-sickle cell disease in Lagos, Nigeria.
        West Afr J Med. 2002; 21: 19-23
        • Wilson N.O.
        • Ceesay F.K.
        • Hibbert J.M.
        • et al.
        Pregnancy outcomes among patients with sickle cell disease at Korle-Bu Teaching Hospital, Accra, Ghana: retrospective cohort study.
        Am J Trop Med Hyg. 2012; 86: 936-942
        • Afolabi B.B.
        • Iwuala N.C.
        • Iwuala I.C.
        • Ogedengbe O.K.
        Morbidity and mortality in sickle cell pregnancies in Lagos, Nigeria: a case control study.
        J Obstet Gynaecol. 2009; 29: 104-106
        • Muganyizi P.S.
        • Kidanto H.
        Sickle cell disease in pregnancy: trend and pregnancy outcomes at a tertiary hospital in Tanzania.
        PLoS One. 2013; 8: e56541
        • Barfield W.D.
        • Barradas D.T.
        • Manning S.E.
        • Kotelchuck M.
        • Shapiro-Mendoza C.K.
        Sickle cell disease and pregnancy outcomes: women of African descent.
        Am J Prev Med. 2010; 38: S542-S549
        • Sun P.M.
        • Wilburn W.
        • Raynor B.D.
        • Jamieson D.
        Sickle cell disease in pregnancy: twenty years of experience at Grady Memorial Hospital, Atlanta, Georgia.
        Am J Obstet Gynecol. 2001; 184: 1127-1130
        • Hutter D.
        • Kingdom J.
        • Jaeggi E.
        Causes and mechanisms of intrauterine hypoxia and its impact on the fetal cardiovascular system: a review.
        Int J Pediatr. 2010; 2010: 9
        • Jauniaux E.
        • Watson A.L.
        • Hempstock J.
        • Bao Y.P.
        • Skepper J.N.
        • Burton G.J.
        Onset of maternal arterial blood flow and placental oxidative stress: a possible factor in human early pregnancy failure.
        Am J Pathol. 2000; 157: 2111-2122
        • Ba S.
        • Xiao Y.
        • Li G.
        • Casiano C.A.
        • Zhang L.
        Effect of maternal chronic hypoxic exposure during gestation on apoptosis in fetal rat heart.
        Am J Physiol Heart Circ Physiol. 2003; 285: H983-H990
        • Nichol D.
        • Stuhlmann H.
        EGFL7: a unique angiogenic signaling factor in vascular development and disease.
        Blood. 2012; 119: 1345-1352
        • Lane P.A.
        • Theodore R.S.
        • Quarmyne M.O.
        • Eckman J.R.
        • Zhou M.
        • Snyder A.B.
        Accuracy of ICD-9 coding for SCD in children and adolescents: results from the Georgia (GA) Rush Surveillance Project.
        Blood. 2014; 124 (4856-4856)
        • Paulukonis S.T.
        • Harris W.T.
        • Coates T.D.
        • Neumayr L.
        • Treadwell M.
        • Vichinsky E.
        Population based surveillance in sickle cell disease: methods, findings and implications from the California registry and surveillance system in hemoglobinopathies project (RuSH).
        Pediatr Blood Cancer. 2014; 61: 2271-2276
        • Brousseau D.C.
        • Panepinto J.A.
        • Nimmer M.
        • Hoffmann R.G.
        The number of people with sickle-cell disease in the United States: national and state estimates.
        Am J Hematol. 2010; 85: 77-78
      2. US Census Bureau; Census 2005: National Tables. Annual Estimates of the Population for the United States and States, and for Puerto Rico: April 1, 2000 to July 1, 2005 (NST-EST2005-01). Available at: http://www.census.gov/popest/data/historical/2000s/vintage_2005. Accessed May 6, 2016.