Sickle Cell Disease and Pregnancy: Does Outcome Depend on Genotype or Phenotype?
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Abstract
Objective: Women with Sickle Cell Disease (SCD) who become pregnant are at risk for serious maternal and fetal complications. Our objective was to determine if pregnancy outcome is dependent on phenotype. Methods: Retrospective cohort study of pregnant women with SCD, including hemoglobin (Hb) SS, Hb SC, and Hb Sβ-thalassemia, between January 1999 and December 2008). Antenatal and neonatal outcomes were compared between pregnancies with painful episodes and those without. The primary outcome was preterm birth (PTB) <37 weeks. Secondary outcomes included maternal medical complications, antenatal complications, delivery outcomes, and neonatal outcomes. Results: 31 women were included (18 (58%) with painful episodes, 13 (42%) without painful episodes). The median number of painful episodes was 2.5 (1 - 19) and these women required a median of 13 total days (1 - 59) of inpatient treatment. At delivery, women who had experienced painful episodes had lower Hb levels and were more likely to be taking chronic narcotic pain medications. The overall incidence of PTB <37wks was 55% and was not significantly different between groups (11 [61%] with painful episodes versus 6 [46%] without painful episodes; p = 0.485). Secondary outcomes were also not significantly different between groups. There was one maternal death. Conclusion: Adverse obstetrical out-comes were more common among women with sickle cell disease who experienced painful crises however, in this small sample, the difference were not statistically significant.
- M. S. Villers, M. G. Jamison, L. M. DeCastro, A. H. James, “Morbidity associated with sickle cell disease in pregnancy,” Am J Obstet Gynecol, Vol. 199, 2008, pp. 125.e1-125.e5.
- “ACOG Practice Bulletin No. 78: Hemoglobinopathies in pregnancy,” Obstet Gynecol, Vol. 109, No. 1, 2007, pp. 229.
- J. Michlitsch, M. Azimi, C. Hoppe, et al., “Newborn screening for hemoglobinopathies in California,” Pediatr Blood Cancer, Vol. 52, No. 4, 2009, pp. 486-90.
- J. A. Smith, M. Espeland, R. Bellevue, et al., “Pregnancy in sickle cell disease: experience of the Cooperative Study of Sickle Cell Disease,” Obstet Gynecol, Vol. 87, No. 2, 1996, pp. 199-204.
- S. M. Tuck, J. W. Studd, J. M. White, “Pregnancy in sickle cell disease in the UK,” Br J Obstet Gynaecol, Vol. 90, No. 2, 1983, pp. 112-7.
- G. R. Serjeant, L. L. Loy, M Crowther, et al., “Outcome of pregnancy in homozygous sickle cell disease,” Obstet Gynecol, Vol. 103, No. 6, 2004, pp. 1278-85.
- K. Hassell, “Pregnancy and sickle cell disease,” Hematol Oncol Clin North Am, Vol. 19, No. 5, 2005, pp. 903-16.
- W. D. Barfield, D. T. Barradas, S. E. Manning, et al., “Sickle cell disease and pregnancy outcomes: women of African descent,” Am J Prev Med, Vol. 38, No. 4 Suppl, 2010, S542-9.
- P. M. Sun, W. Wilburn, B. D. Raynor, D. Jamieson, “Sickle cell disease in pregnancy: twenty years of experience at Grady Memorial Hospital, Atlanta, Georgia,” Am J Obstet Gynecol, Vol. 184, No. 6, 2001, pp. 1127-30.
- G. R. Serjeant, I. Hambleton, M. Thame, “Fecundity and pregnancy outcome in a cohort with sickle cell-haemoglobin C disease followed from birth,” BJOG, Vol. 112, No. 9, 2005, pp. 1308-14.
- O. S. Platt, B. D. Thorington, D. J. Brambilla, et al., “Pain in sickle cell disease: rates and risk factors,” N Engl J Med, Vol. 325, No. 1, 1991, 11-16.
- D. R. Powars, M. Sandhu, J. Niland-Weiss, et al., “Pregnancy in sickle cell disease,” Obstet Gynecol, Vol 67, No. 2, 1986, pp. 217-28.
- C. E. Berzolla, N. S. Seligman, K. Dysart, et al., “Obstetrical outcomes of pregnancies complicated by sickle crisis,” Am J Hematol, Vol. 84, 2009, pp. E40.
- E. Z. Fiakpui, E. M. Moran. “Pregnancy in the sickle hemoglobinopathies,” J Reprod Med, Vol. 11, No. 1, 1973, pp. 28-34.
- M. Koshy, L. Burd, D. Wallace, A. Moawad, J. Baron, “Prophylactic red-cell transfusions in pregnant patients with sickle cell disease. A randomized cooperative study,” N Engl J Med, Vol. 319, No. 22, 1988, pp. 1447-52.