Evaluation of Stillbirth Among Pregnant People With Sickle Cell Trait

Canelón, Silvia P.; Butts, Samantha; Boland, Mary Regina

doi:10.1001/jamanetworkopen.2021.34274

Cited by 6 publications

(7 citation statements)

References 56 publications

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“…The most noticeable finding in this study is the 15-fold increase in the risk of IUFD among women with SCT (3%) compared to women with normal hemoglobin (0.2%) (P<0.0001). Similar results were reported by Canelon et al's study [19]. This might be attributed to the sickling of maternal blood red cells at the placental blood vessels which may lead to decreased oxygenation, thrombosis, and placental infarctions causing intrauterine fetal hypoxia [20].…”

Section: Discussionsupporting

confidence: 76%

“…In this retrospective study, SCT occurred in approximately 16.4% of all patients delivered in SMC during the study period. The incidence is considered relatively high in comparison to other studies which reported a lower incidence of SCT patients [8,19]. Canelon et al [19] and Larrabee et al [8] reported that the incidence of SCT among parturition mothers is 3.9% in Pennsylvania and 10.2% among African American women, respectively.…”

Section: Discussionmentioning

confidence: 76%

“…The incidence is considered relatively high in comparison to other studies which reported a lower incidence of SCT patients [8,19]. Canelon et al [19] and Larrabee et al [8] reported that the incidence of SCT among parturition mothers is 3.9% in Pennsylvania and 10.2% among African American women, respectively. This can be explained by the higher incidence of SCT in Bahrain 14.7% as reported by the newborn screening service in 2010 [1].…”

Section: Discussionmentioning

confidence: 76%

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Sickle Cell Trait and Adverse Pregnancy Outcomes: Is There a Link?

Buhusayyen¹,

Isa²,

Kamal³

2022

Cureus

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The objective is to assess the overall prevalence of maternal and neonatal pregnancy-related complications, and to compare their frequency among women with sickle cell trait (SCT) and those with normal hemoglobin patterns to examine the association between SCT and maternal and neonatal outcomes. MethodsA retrospective cross-sectional case-control study was conducted by reviewing medical data from the labor room registry book and electronic database. All pregnant ladies delivered in Salmaneya medical complex from January 1 to December 31, 2019 were included. Patients were divided into two groups based on the presence or absence of SCT. Adverse maternal and neonatal outcomes were compared between the two groups. ResultsOut of the 5,067 pregnant women reviewed, 934 (18.4%) were included (460 (49.3%) with SCT and 474 (50.7%) with healthy controls). Overall, maternal, and neonatal complications were noted in 40.8% (n=381) and 16.3% (n=152), respectively. In univariate analysis, patients with SCT were significantly more likely to underwent cesarean sections compared to healthy women, 28.7% (n=132) vs. 21.7% (n=103), respectively (P=0.044) and to have more intrauterine fetal death (3% [n=14] vs. 0.2% [n=1], respectively (P<0.0001). No significant differences were found between the two groups in terms of the occurrence of the pregnancyrelated hypertensive disorder, gestational diabetes, small for gestational age, and preterm delivery. ConclusionThe result of this large, retrospective cross-sectional, case-control study shows that pregnant women with SCT were associated with an increase in intrauterine fetal death in comparison with pregnant women with normal hemoglobin. There were no differences found in pregnancy-related hypertensive disorder, gestational diabetes, small for gestational age, and preterm delivery. This result will emphasize the requirement of additional studies to scrutinize these findings and to determine whether there may be a benefit of a unique antenatal surveillance guideline for such patients.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 76%

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Sickle Cell Trait and Adverse Pregnancy Outcomes: Is There a Link?

Buhusayyen¹,

Isa²,

Kamal³

2022

Cureus

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“…It was, for example, the only country in which HIV 2 was more widespread than HIV 1 in the past decades ( 23 ); and multidrug resistant uberculosis (TB) has lower incidence than in other West-African countries ( 24 ). Furthermore, the very high maternal and infant mortality rates of Guinea Bissau (child mortality rates are the highest worldwide at 152.5 per 1,000 livebirths) ( 25 ), as well as the increased risk of stillbirth in SA carriers ( 26 ), could justify a higher number of children with SS dying earlier and not being diagnosed. Also, there is a lower rate of HbSA children being born from S carrier mothers.…”

Section: Discussionmentioning

confidence: 99%

Distribution of HbS Allele and Haplotypes in a Multi-Ethnic Population of Guinea Bissau, West Africa: Implications for Public Health Screening

et al. 2022

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BackgroundSickle Cell Disease (SCD) is an inherited condition that is widespread globally and especially in malaria-endemic West African countries. Limited epidemiological data on SCD are available for Guinea Bissau, where newborn screening is not yet implemented, routine diagnosis is not available, and care is case directed.MethodsDried blood spots were collected from children accessing two hospitals managed by Italian Non-Governmental Organizations in the capital city of Bissau and sent to Padova for Hemoglobin (Hb) quantification through HPLC and molecular analysis. Beta globin gene analysis was performed in all; and Hb haplotype of the HbSS and HbSA patients was performed in South Africa. One hundred samples belonging to the most frequent ethnic groups were randomly selected for detection of G6PD mutations.ResultsSamples from 848 consecutive children (498 males and 350 females, mean age 6.8 years) accessing the two hospitals were analyzed: 6.95% AS (4.42% allelic frequency), 0.94% SS, and 0.23% AC. 376G G6PD allelic frequency was 24%; 14.8% in AS individuals. The Senegal haplotype was the most prevalent (31%), and the proposition of chromosomes with the atypical haplotype was surprisingly high (56%).ConclusionOur study demonstrates a significant frequency of the HbS allele in the population of Guinea Bissau supporting the implementation of screening strategies. The differences among ethnic groups can help guide targeted interventions for SCD awareness campaigns and determine priority areas for public health interventions. The pilot analysis on haplotypes reveals a large proportion of the atypical haplotype, which may be indicative of a genetically heterogeneous population.

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“…13 Pregnancy is a stressful physiological event, often associated with emotional changes, anxiety, and depression. [14][15] Impact of SCT on pregnancy outcome has been equivocal, with some studies have reported adverse outcomes, [16][17][18][19][20][21][22][23][24][25][26][27] and contraception has been suggested, 28 whereas others have not, [29][30] also in consideration of greater resistance of carriers to malaria in pregnancy 29. The reasons for the contradictory findings are not clear. However, factors such as nutritional status before and during pregnancy may play a significant role.…”

mentioning

confidence: 99%

Adverse Pregnancy Outcomes in Sickle Cell Trait: A Prospective Cohort Study Evaluating Clinical and Haematological Parameters in Postpartum Mothers and New-Borns.

Al-Kindi¹

2022

Mediterr J Hematol Infect Dis

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– Sickle cell trait (SCT) is a condition caused by the inheritance of a single allele of the abnormal haemoglobin beta gene, HbS. Carriers of SCT are generally asymptomatic, and they do not manifest the haematological and clinical abnormalities of sickle cell anaemia (SCA). However, there is evidence that they display some of the symptoms in stressful situations. Pregnancy is a stressful physiological event, and it is not clear if SCT adversely affects pregnancy outcomes, particularly those from the developing countries, who regularly suffer from nutritional insufficiency. Objective – This study aims to investigate pregnancy outcomes in Sudanese women with SCT. Subjects and methods – Pregnant women with (HbAS, n=34) and without (HbAA, n=60) SCT were recruited during their first trimester by El Obeid Hospital, Kordofan, Western Sudan. Ethical approval from the Faculty of Medicine, University of Khartoum, and informed consent from the participants were obtained. Detailed anthropometric, haematological, clinical, obstetric and birth outcome data were documented. Blood samples were collected at enrolment and delivery. Results – At enrolment, the first trimester, the SCT group did not manifest SCA symptoms, and there was no difference in any of the haematological parameters between the SCT and control groups. At delivery, the women with SCT compared with the control group had lower levels of haemoglobin (Hb, p=0.000), packed cell volume (PCV, p=0.000), mean corpuscular haemoglobin (MCH, p=0.002) and neutrophil counts (p=0.045) and higher mean corpuscular volume (MCV, p=0.000) and platelet counts (p=0.000). Similarly, at delivery, the babies of SCT women had lower birth weight (p=0.000), lower Hb (p=0.045), PCV (p=0.000), MCH (p=0.000) and higher neutrophil (p=0.004) and platelet counts (p=0.000) than the babies of the healthy control group. Additionally, there were more miscarriages, stillbirths and admissions to the Special Care Baby Unit (SCBU) in the SCT group. Conclusions – The study revealed that SCT is associated with adverse pregnancy outcomes, including maternal and neonatal anaemia, low birth weight and increased risk of still birth, miscarriage and admission to SCBU. Therefore, pregnant women with SCT should be regarded as a high-risk group, and given pre-conceptual advice and multidisciplinary antenatal and postnatal care.

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Evaluation of Stillbirth Among Pregnant People With Sickle Cell Trait

Cited by 6 publications

References 56 publications

Sickle Cell Trait and Adverse Pregnancy Outcomes: Is There a Link?

Sickle Cell Trait and Adverse Pregnancy Outcomes: Is There a Link?

Distribution of HbS Allele and Haplotypes in a Multi-Ethnic Population of Guinea Bissau, West Africa: Implications for Public Health Screening

Adverse Pregnancy Outcomes in Sickle Cell Trait: A Prospective Cohort Study Evaluating Clinical and Haematological Parameters in Postpartum Mothers and New-Borns.

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