Sickle cell disease may increase severe maternal morbidity risk among black women

Sickle cell disease (SCD) was found to be a significant factor in the racial differences in severe maternal morbidity (SMM) and was linked to a higher risk of SMM in Black people, says an article published in the Journal of American Medical Association.

The link between severe maternal morbidity and sickle cell disease is poorly understood. Therefore, Nansi Boghossian and colleagues undertook this study to investigate the relationship between SCD and racial inequalities in SMM and with SMM among Black people.

This cohort research was a retrospective population-based analysis of people with and without SCD who had a live birth or a fetal death in 5 states (California [2008-2018], Pennsylvania [2008-2014], Michigan [2008-2020], Missouri [2008-2014], and South Carolina [2008-2020]). Between July and December 2022, data were analyzed. Using classifications from the ninth and tenth revisions of the International Classification of Diseases, sickle cell illness was discovered during the delivery hospitalization. SMM including and excluding blood transfusions during labor and delivery were the main results. 

The key findings of this study were:

1. From a total of 8 693 616 patients, 956 951 (11.0%) were Black, and 3586 (0.37%) of them had SCD.

2. In comparison to Black people without SCD, Black people with SCD had higher rates of Medicaid insurance (70.2% vs. 64.6%), cesarean deliveries (44.6% vs. 34.0%), and residence in South Carolina (25.2% vs. 21.5%).

3. Sickle cell disease was responsible for 8.9% and 14.3%, respectively, of the Black-White discrepancy in SMM and non transfusion SMM. SCD complicated 0.37 percent of births among Black people, while it was a factor in 4.3% of SMM cases and 6.9% of non transfusion SMM cases.

4. The adjusted RRs of SMM and non-transfusion SMM during the delivery hospitalization were 3.8 and 6.5, respectively, whereas the crude RRs of Black persons with SCD compared to those without were 11.9 and 19.8, respectively.

5. The SMM indicators with the greatest adjusted RRs were blood transfusion, puerperal cerebrovascular diseases, and air and thrombotic embolism.

Reference:

Boghossian, N. S., Greenberg, L. T., Saade, G. R., Rogowski, J., Phibbs, C. S., Passarella, M., Buzas, J. S., & Lorch, S. A. (2023). Association of sickle cell disease with racial disparities and severe maternal morbidities in Black individuals. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2023.1580