Excess Risk of Maternal Death from Sickle Cell Disease in Jamaica: 1998–2007

Abstract

BackgroundDecreases in direct maternal deaths in Jamaica have been negated by growing indirect deaths. With sickle cell disease (SCD) a consistent underlying cause, we describe the epidemiology of maternal deaths in this population.MethodsDemographic, service delivery and cause specific mortality rates were compared among women with (n = 42) and without SCD (n = 376), and between SCD women who died in 1998–2002 and 2003–7.ResultsWomen with SCD had fewer viable pregnancies (p: 0.02) despite greater access to high risk antenatal care (p: 0.001), and more often died in an intensive care unit (p: 0.002). In the most recent period (2003–7) SCD women achieved more pregnancies (median 2 vs. 3; p: 0.009), made more antenatal visits (mean 3.3 vs. 7.3; p: 0.01) and were more often admitted antenatally (p:<0.0001). The maternal mortality ratio for SCD decedents was 7–11 times higher than the general population, with 41% of deaths attributable to their disorder. Cause specific mortality was higher for cardiovascular complications, gestational hypertension and haemorrhage. Respiratory failure was the leading immediate cause of death.ConclusionsWomen with SCD experience a significant excess risk of dying in pregnancy and childbirth [MMR: (SCD) 719/100,000, (non SCD) 78/100,000]. MDG5 cannot be realised without improving care for women with SCD. Tertiary services (e.g. ventilator support) are needed at regional centres to improve outcomes in this and other high risk populations. Universal SCD screening in pregnancy in populations of African and Mediterranean descent is needed as are guidelines for managing SCD pregnancies and educating families with SCD.

Determinants of adverse pregnancy outcomes among Sickle Cell Disease deliveries at a tertiary hospital in Tanzania from 1999 to 2011

“…The current study has showed that the incidence of adverse pregnancy outcomes was high among SCD deliveries with more than two thirds of all SCD deliveries ending in one or more adverse outcomes. This high incidence of adverse outcomes concurs with the findings by other international studies that generally report increased adverse pregnancy outcomes among SCD deliveries [5][6][7][8][9][10][11]13,[17][18][19]]. …”

“…An increased risk of pre-eclampsia and pregnancy-induced hypertension have been reported in some studies [6,14] but denied by others [5,10,11,15]. Likewise increased risk for hemorrhage in SCD pregnancy and maternal mortality have been reported by some studies [5,7,[16][17][18] but not all [6,10-11, 13,15]. The above findings conclude that adverse perinatal and maternal outcomes are significant in SCD.…”

“…These variables may be seen as proxy indicators of prenatal care (antenatal visits, mode of delivery and referral) or prenatal fetal condition (gestation age/prematurity). Studies have shown that women with SCD in pregnancy seek prenatal care services more frequently than the non SCD [5,7] but to what extent these services help them largely depends on the quality of offered services. In Benin, for example, the observed excessive adverse pregnancy outcomes among SCD deliveries were very markedly alleviated with the introduction of a better standard of care [18].…”

“…Impressive outcomes of SCD in pregnancy are not limited in high income countries. Some studies have reported impressive SCD delivery outcomes in low resource countries as a result of improved quality of care as the case of Benin and Jamaica [7,18].…”

“…The most commonly mentioned complications include spontaneous abortions, premature labor, fetal growth retardation, low birth weight, delivery by Caesarean section, infections, thromboembolic events, hypertensive disorders, hemorrhages and retained placenta [5][6][7][8][9][10][11][12][13]. Most studies seem to agree on increased adverse fetal outcomes but there is a wide discrepancy on the occurrence of maternal compli-…”