Evidence for Prophylactic Transfusion during Pregnancy for Women with Sickle Cell Disease

Whittington, Julie R; Magann, Everett F.; Ounpraseuth, Songthip; Chang, Jon N; Whitcombe, Dayna D; Morrison, John C.

doi:10.14423/smj.0000000000001233

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…indicate advantages of not delaying use until an emergency occurs. 50 A retrospective review of Burkina-Faso women who (a) received at least one exchange transfusion, (b) required an emergency blood transfusion, or (c) had no transfusion at all, found that of 164 women (53, 32 and 79 respectively), third trimester pregnancy complications were less prevalent ( p <0.0001) in the exchange transfusion (58.5%) than the emergency transfusion (78.5%) or no transfusion group (91.1%). Maternal mortality was also lower (5.7%; 12.5%; 12.6%; [ p = 0.009] respectively).…”

Section: Discussionmentioning

confidence: 99%

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)

McCaw-Binns

Campbell²,

Harris

et al. 2022

eClinicalMedicine

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Summary Background Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998–2007 their maternal mortality ratio was 7–11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care. Methods Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open. Findings Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with ( p = 0.502) and without SCD ( p = 0.629). The MMR among women with and without SCD in 2008–17 was 378.1 ( n = 41) and 89.2/100,000 live births ( n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07–5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36–3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051). Interpretation MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children. Funding No external funding was provided.

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Section: Discussionmentioning

confidence: 99%

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)

McCaw-Binns

Campbell²,

Harris

et al. 2022

eClinicalMedicine

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“…Whether or not SPBTs are beneficial in pregnant SCD patients remains a matter of debate [ 21 , 22 , 23 , 24 ]. Importantly, transfusion techniques and timing of SP(E)BT vary throughout the different studies probably explaining the contradictory results.…”

Section: Discussionmentioning

confidence: 99%

“…Three pregnancies were terminated prematurely by elective abortions and three pregnancies resulted in spontaneous abortions, compared to six spontaneous abortions of the 22 pregnancies in patients with no prior exposure to HC. None of the patients with HbS/C disease experienced spontaneous abortions/stillbirths or received HC prior to pregnancy (median age at conception: 28 years, range [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35].…”

Section: Maternal Fetal and Neonatal Outcomesmentioning

confidence: 99%

Pregnancies and Neonatal Outcomes in Patients with Sickle Cell Disease (SCD): Still a (High-)Risk Constellation?

Proske

Distelmaier

Aramayo-Singelmann

et al. 2021

JPM

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Background: This monocentric study conducted at the University Hospital of Essen aims to describe maternal and fetal/neonatal outcomes in sickle cell disease (SCD) documented between 1996 to 2021 (N = 53), reflecting the largest monocentric analysis carried out in Germany. Methods/Results: 46 pregnancies in 22 patients were followed. None of the patients died. In total, 35% (11/31) of pregnancies were preterm. 15 pregnancies in eight patients were conceived on hydroxycarbamide (HC), of which nine had a successful outcome and three were terminated prematurely. There was no difference regarding the rate of spontaneous abortions in patients receiving HC compared to HC-naive patients prior to conception. In patients other than HbS/C disease, pregnancies were complicated by vaso-occlusive crises (VOCs)/acute pain crises (APCs) (96%, 23/24); acute chest syndrome (ACS) (13%, 3/24), transfusion demand (79%, 19/24), urinary tract infections (UTIs) (42%, 10/24) and thromboembolic events (8%, 2/24). In HbS/C patients complications included: VOCs/APCs (43%, 3/7; ACS: 14%, 1/7), transfusion demand (14%, 1/7), and UTIs (14%, 1/7). Independent of preterm deliveries, a significant difference with respect to neonatal growth in favor of neonates from HbS/C mothers was observed. Conclusion: Our data support the results of previous studies, highlighting the high rate of maternal and fetal/neonatal complications in pregnant SCD patients.

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“…Additional studies are needed to understand the benefits of prophylactic transfusions in management of SCD in pregnancy. 9 Chronic organ injuries, which are caused by SCD, are overburdened by the physiological adaptations that occur in the hematologic, pulmonary and renal systems during pregnancy, leading to increasing rate of obstetric complications such as ACS, worsening of vaso-occlusive crisis, and preeclampsia/eclampsia. In recent times, there has been a debate to redefine hypertensive disorders of pregnancy in women with SCD because as compared with general population, these patients have lower blood pressures at steady state.…”

Section: Introductionmentioning

confidence: 99%

Fetomaternal Outcomes among Patients with Sickle Cell Disease: A Retrospective Study

Chaudhary¹,

Pitre²

2023

Journal of South Asian Federation of Obstetrics and Gynaecology

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Introduction:We are presenting a study on pregnancy with sickle cell disease (SCD), which is the most common genetic disorder with high mortality and morbidity with varying severity. It is an increasing global health problem. Materials and methods: The cases were retrieved and a case-control study was done at GMERS Medical College and Hospital over a duration of 3 years from November 2019 to September 2022. General characteristics of 32 pregnancies and their fetomaternal complications were studied. A descriptive statistical analysis of the above-mentioned data was performed, and percentages were calculated. Results: Among 32 cases, 62.5% of cases were multigravida. Anemia (moderate and severe anemia) was the most common complication (71.87%). Hemolytic crisis was seen in 18.75%, and painful crises were seen in 6.25% cases, 9.37% of cases had acute chest syndrome. Complications such as urinary tract infection (UTI) were seen in 6.25%, preeclampsia in 34.37%, 56.25% had preterm deliveries, and history of miscarriage and stillbirth was seen in 34.37%. Intrauterine growth restriction (IUGR) was seen in 9.37%, neonatal death -3.12%, low birth weight -62.5%, fetal distress -12.50%, and intrauterine fetal death (IUFD) -6.25%. Maternal mortality was seen in 12.50% cases. Discussion: Because of physiological adaptations along with sickle cell crisis, maternal and fetal complications are more in SCD patients. Conclusion:The study will help understand the outcomes of pregnancy in SCD patients and will help for a better approach in treating these patients.

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Evidence for Prophylactic Transfusion during Pregnancy for Women with Sickle Cell Disease

Cited by 4 publications

References 29 publications

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)

Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)

Pregnancies and Neonatal Outcomes in Patients with Sickle Cell Disease (SCD): Still a (High-)Risk Constellation?

Fetomaternal Outcomes among Patients with Sickle Cell Disease: A Retrospective Study

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