Pregnant Women with Sickle Cell Disease, Especially SS-type, at Risk of Complications

Women with sickle cell disease have a high risk of complications during pregnancy, according to new research from French Guiana. The findings also show that women with the more severe SS-type sickle cell disease are more likely to have premature babies, and to suffer health problems themselves, than women with less severe disease types.

The study, “Pregnancy in Sickle Cell Disease Is a Very High-Risk Situation: An Observational Study,” published in the journal Obstetrics and Gynecology International, underscores that pregnant women with sickle cell disease should be supervised by a multidisciplinary team that includes primary care physicians, obstetricians, and a specialist in sickle cell disease.

In an attempt to pinpoint what complications are common among pregnant women with sickle cell disease, researchers at the Centre Hospitalier de Cayenne Andrée Rosemon in French Guiana — a French territory in South America — analyzed health records of 62 pregnancies in 44 women between 2007 and 2013.

The women had three different types of sickle cell disease. Those with the SS-type were observed in 27 pregnancies, SC-type in 30, and women with S-beta type disease with five pregnancies. No women died during the study period.

Researchers report that among women with SS-type disease, 41 percent of babies were born prematurely, while preterm births occurred in only 23 percent of women with the SC-type, and none in those with S-beta disease.

SS women also had a greater risk of miscarriage at 11 percent, and three babies died during the pregnancy, compared to a 3 percent miscarriage rate among SC women. High blood pressure during pregnancy, cesarean sections, and stillbirth were also not uncommon.

In addition to the delivery-related complications, 19 percent of  SS women had a sickle-cell crisis — blocked blood flow caused by clumping of abnormal red blood cells. SC women experienced sickle cell crisis in 27 percent of cases. Acute chest syndrome — blockage of blood flow particularly in the lungs — and urinary tract infections were equally common among SS and SC women.

Pregnancies could be risky for the newborn babies, too, with babies of SS-type women ending up in neonatal intensive care in 15 percent of cases, compared to 7 percent in SC pregnancies. Researchers noted that growth retardation and abnormal heart rate in the unborn child were common.

Women with S-beta disease had a low rate of complications, but the small number of women with this type of the disease prevented the study’s researchers from drawing firm conclusions about real risk in this group.

The research team also found no evidence that blood transfusions might have affected the rate of complications. The authors, however, note that the study was not designed to detect such effects, and that more studies are needed to investigate a possible impact of blood transfusions on complications during pregnancy in sickle cell disease.