Pregnancy Outcome among Women with Sickle Cell Disease in a Tertiary Health Institution in Abakaliki: A Retrospective Case-Control Study

Abstract

Background: Sickle cell disease (SCD) is associated with an increased risk of medical complications during pregnancy and they constitute a very high-risk group with associated increased maternal and perinatal morbidity and mortality especially in a low resource setting. Objective: To determine the pregnancy outcomes among women with sickle cell disease delivered at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Materials and methods: This was a 7-year retrospective case-control study undertaken from January 2012 to December 2018 that compared pregnancy outcomes among women with and without haemoglobinopathy in pregnancy managed at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA). The statistical analysis was done using SPSS version 22. Results: The incidence of SCD in pregnancy was 6.9 per 1000 deliveries. The age distribution of the women ranged from 18 to 45 years of age with a mean of 26.4 ± 2.4 years. The incidence of stillbirth was higher in women with HbSS when compared with HbSC but this difference did not reach statistical significance (P = 0.05). Live birth rate was higher in women with HbAA genotype when compared with those with SCD. Caesarean section rate was higher among women with SCD when compared with control (SS versus AA, P = 0.004; SC versus AA, P < 0.0001). Babies of mothers with HbSS and HbSC have significantly lower mean birth weight when compared with those of mothers with HbAA (SS versus AA, P = 0.0007; SC versus AA, P < 0.0001). Similarly maternal genotype has a significant effect on other adverse fetal outcomes such as Apgar scores < 7 at 5 minutes and preterm delivery. Women with SCD had higher incidence of pregnancy-induced hypertension and preeclampsia when compared with control. Maternal genotypes have no significant effect on other maternal complications. There was no maternal death in this study. Conclusion: This study showed that the maternal mortality in SS and SC patients in pregnancy was not different from those of HbAA women in our hospital, although other maternal and fetal outcomes were still poor among women with SCD when compared with women without SCD.