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BackgroundSickle cell disease (SCD) is a multisystem disease characterised by vaso-occlusive crisis, chronic anaemia and a shorter lifespan. More patients with SCD are living till reproductive age and contemplating pregnancy. Pulmonary complications in pregnancy are significant causes of maternal morbidity and mortality but yet this has not been systematically quantified. A systematic review and meta-analysis were conducted to quantify the association between SCD and pulmonary complications in pregnancy.MethodsMEDLINE, EMBASE, Web of Science, Cochrane and Maternity and Infant Care databases were searched for publications between January 1998 and April 2019. Observational studies involving at least 30 participants were included. Random-effects models were used for statistical meta-analysis.FindingsTwenty-two studies were included in the systematic review and 18 in the quantitative analysis. The meta-analysis included 3964 pregnancies with SCD and 336 559 controls. Compared with women without SCD, pregnancies complicated by SCD were at increased risk of pulmonary thromboembolism (relative risk (RR) 7.74; 95% CI 4.65 to 12.89). The estimated prevalence of acute chest syndrome and pneumonia was 6.46% (95% CI 4.66% to 8.25%), with no significant difference between the HbSS and HbSC genotypes (RR 1.42; 95% CI 0.90 to 2.23).InterpretationThis meta-analysis highlighted a strong association between SCD and maternal pulmonary complications. Understanding the risks of and the factors associated with pulmonary complications would aid preconceptual counselling and optimal management of the condition in pregnancy, thereby reducing associated maternal morbidity and mortality.PROSPERO registration numberCRD42019124708.

The absorption of amoxycillin from the gastro-intestinal tract, with or without oral metoclopramide, has been evaluated. Levels of amoxycillin in the maternal blood and liquor prior to the induction of labour were of a therapeutic level against many organisms. However, absorption during labour, as reflected by maternal blood levels at delivery and cord blood levels, suggests that amoxycillin is poorly absorbed and may not reach adequate therapeutic levels in the fetus. Oral metoclopramide did not improve the absorption of amoxycillin. Should a parenteral form of amoxycillin become available, a similar study of blood and liquor levels may indicate that, like ampicillin, intramuscular administration is required for adequate therapeutic use at this stage of pregnancy. Until an oral formulation of an appropriate antibiotic is available which gives rapid absorption may and a sustained level of the chemotherapeutic agent in this situation, parenteral administration of an appropriate antibiotic remains mandatory.