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
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Article Info
Publication History
Published online: May 27, 2016
Accepted:
May 20,
2016
Received in revised form:
May 10,
2016
Received:
March 4,
2016
Footnotes
The authors report no conflict of interest.
Cite this article as: Kuo K, Caughey AB. Contemporary outcomes of sickle cell disease in pregnancy. Am J Obstet Gynecol 2016;215:505.e1-5.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
