Sickle Cell Disease during pregnancy Significant Risk Factor for Maternal-Fetal Morbidity, finds study
Researchers have found that sickle cell disease (SCD) poses a significantly increased risk for maternal-fetal morbidities, especially in the last month of pregnancy. This is concluded by one of the largest studies into SCD pregnancies in India, undertaken at Kasturba Maternity Hospital, Gujarat. The study was conducted by Kapilkumar Dave and colleagues published in the International Journal of Obstetrics and Gynecology.
The study sought to quantify maternal-fetal risks associated with SCD and sickle cell traits and explore the epidemiology of maternal morbidity. The results are of utmost importance for critical insights into how SCD affects pregnancy outcomes and can provide actionable information on strategies to improve care in resource-limited settings.
This retrospective cohort study enrolled all pregnant women admitted to Kasturba Maternity Hospital from 2016 to 2021. In five years, there were 24,256 deliveries. The screening for SCD was done in these women, and pregnancy-related complications are documented meticulously. The analysis of risks was done with the help of Poisson and logistic regression models after accounting for confounding variables.
Among the 24,256 deliveries, 354 women (1.5%) had SCD, and 4216 women (17.4%) were identified as having the sickle cell trait.
Maternal Morbidity Risks:
• Women with SCD had a significantly higher risk as compared to normal pregnancies :
• Maternal death: AOR 13.7 (95% CI: 4.5-42.7).
• Anemia: AOR 6.8 (95% CI: 4.5-10.2).
• Severe anemia: AOR 4.3 (95% CI: 3.3-5.6).
• Preterm delivery: AOR 4.5 (95% CI: 3.6-5.7).
• Cesarean section: AOR 5.5 (95% CI: 4.7-7.0).
Fetal Outcomes:
• Stillbirth: AOR 3.4 (95% CI: 2.3-5.3).
• Low birth weight: AOR 3.1 (95% CI: 2.4-3.9).
Timing of Risk:
• The greatest risks of maternal morbidities were in the last month of gestation.
SCD Severity:
• Pregnant women with severe manifestations of SCD before conception were at increased risk for complications during pregnancy.
Maternal-fetal morbidities are increased by sickle cell disease, especially the risks of maternal death, anemia, preterm delivery, and poor fetal outcomes. This is a critical final month of gestation requiring high-level care for those women with SCD who had prior severe manifestations. This underscores the need for high-impact healthcare interventions.
Reference:
Dave K, Desai S, Desai T, Desai G. Adverse maternal and fetal outcomes among tribal pregnant women suffering from sickle cell disease: A retrospective cohort study in a community-based hospital situated in a tribal block of Gujarat, India. Int J Gynaecol Obstet. 2024 Nov 6. doi: 10.1002/ijgo.15999. Epub ahead of print. PMID: 39503239.
