Women with SCD at higher risk of complications during pregnancy
Study supports need for close monitoring of pregnant women with SCD
Despite advancements in medical care, pregnant women with sickle cell disease (SCD) are at a higher risk of complications and require close monitoring, a nationwide French study has found.
SCD is associated with a significantly higher likelihood of maternal and fetal complications, preterm birth, and caesarean sections (C-sections), data show.
“Although there has been a significant decrease in maternal and perinatal mortality and morbidity rates over the past few decades, SCD during pregnancy remains linked to a high incidence of severe maternal and fetal complications,” researchers wrote. “Research findings strongly support the need for close monitoring of all pregnant patients with SCD, as advocated by most current guidelines.”
The study, “Maternal and perinatal outcomes of sickle cell disease in pregnancy: A nationwide study in France,” was published in the British Journal of Haematology.
Research has shown that the risk of maternal complications is higher for pregnant women with SCD. However, the majority of past studies on pregnancy outcomes in SCD has been limited to single-center studies conducted in the U.S. and Canada, or to statewide analyses carried out in the U.S.
Analysis included 1,022 pregnancies in women with SCD in France
In the new study, a team led by researchers at the Université de Paris analyzed data from the French national health database for pregnancy and fetal outcomes in women, ages 15-55, from 2013 to 2020. The analysis included 1,022 pregnancies in women with SCD and 5,751,058 pregnancies in women who did not have SCD and who served as the control group.
“In the present prospective, nationwide study in France, we sought to describe maternal and fetal outcomes of pregnancy in women with SCD versus women without SCD,” the researchers wrote.
More than two-thirds (69.8%) of women with SCD were not receiving any specific treatment for the disease. Among the 398 who were on treatment, the majority (75%) were taking hydroxyurea, while 15% were receiving blood transfusions. About 10% were receiving both treatments.
Women with SCD were significantly more likely to receive pain management with analgesics during pregnancy when compared with the controls. Analgesics more frequently prescribed to women with SCD included aspirin (17.7% vs. 3.4%) and exoneparin (10.6% vs. 1.3%). Oxygen therapy was also more frequently administered during pregnancy to women with sickle cell disease (27.8% vs. 0.2%).
The transfusion rate increased greatly in women with SCD during pregnancy, rising from 16.9% in the nine months before pregnancy to 49.7% during pregnancy.
Women with SCD significantly more likely to develop pre-eclampsia
Women with SCD were significantly more likely to develop pre-eclampsia during pregnancy when compared with women who did not have SCD (9.6% vs. 1.7%). Pre-eclampsia is a pregnancy complication characterized by high blood pressure and organ damage.
Other conditions that were significantly more likely to occur in pregnant women with SCD included eclampsia (0.39% vs. 0.05%), postpartum hemorrhage (8.3% vs. 4.1%), genitourinary infections (8.4% vs. 5%), and pulmonary embolism (0.7% vs. 0.02%). The rate of C-sections was also markedly higher among women with SCD (52.8% vs. 18.2%). However, no differences in the frequency of spontaneous miscarriages were found between groups.
The frequency of C-sections was significantly higher in SCD women who received treatment compared with those who did not (63.6% vs. 48.2%), as was the incidence of postpartum hemorrhage (12.3% vs. 6.6%). The incidence of pre-eclampsia was similar in the two groups (11% vs. 8.9%).
Preterm birth (before 37 weeks of gestation) was much more common in women with SCD (28.5% vs. 5.6%). Babies from women with SCD had a lower birth weight (mean of 2.8 kg vs. 3.3 kg), and were more likely to experience adverse outcomes (22.4% vs. 8.1%) and fetal malformations (6.3% vs. 3.4%). No differences were seen between the two groups in mortality risk within a year after birth.
“Overall, despite advances in SCD management, pregnancy in SCD remains a high-risk condition, for both mothers and babies,” the researchers wrote.
About the Author
