Fecundity and pregnancy outcome in a cohort with sickle cell‐haemoglobin C disease followed from birth

Abstract

Objective To compare pregnancy outcome in sickle cell‐haemoglobin C (SC) disease with that in homozygous sickle cell (SS) disease and age‐matched controls with a normal haemoglobin (AA) genotype. Design A cohort study followed from birth. Setting Sickle Cell Clinic, University Hospital and other Jamaican hospitals. Population Ninety‐five pregnancies in 43 patients with SC disease, 94 pregnancies in 52 patients with SS disease and 157 pregnancies in 68 controls. Methods Systematic review of all pregnancies occurring in sample population. Kaplan–Meier analysis for interval to first pregnancy, and the t test, χ2 test or Fisher's exact test as appropriate; correction was made for multiple testing and multiple linear regression was used for analysis of determinants of birthweight. Main outcome measures Age at menarche, interval to first pregnancy, outcome of pregnancy, maternal complications and possible predictors of low birthweight. Results Menarche was marginally delayed in SC disease compared with AA controls (median age 13.7 vs 13.0 years, P= 0.02) but age at first pregnancy was similar (median age 22.5 vs 20.1 years, P= 0.32). Pregnancy outcome in SC disease did not differ from AA controls but compared with SS disease there were marginally fewer miscarriages, more live deliveries and greater birthweight. The prevalence of pregnancy‐induced hypertension, pre‐eclampsia, antepartum or postpartum haemorrhage in SC disease did not differ from AA controls but the prevalence of sickle‐related complications was similar to SS disease. Conclusions Contrary to some claims, pregnancy outcome in SC disease is generally benign compared with SS disease.

Pregnancy complications and perinatal outcomes of women with hemoglobinopathies

“…In this study, the preterm labor was 17.06 more prevalent among women with pregnancies with hemoglobinopathies compared to those without hemoglobinopathies. These findings corroborated the studies in Cuba and Jamaica, which received high frequency of preterm births [18,21,22].…”

“…It should be emphasized that in sickle cell disease there is an increased risk for urinary tract infections. When they occur during pregnancy, they may contribute to other complications such as miscarriage or preterm labor [21]. In a study conducted in Tanzania with 149 pregnant women, there was an excess risk of maternal deaths by sickle cell disease compared with those who had not.…”

“…Although prematurity is prevalent in this disease, it cannot be considered the only factor that may cause the newborn to the Neonatal Intensive Care Unit [21,22].…”

“…There was a gap in the literature on neonatal infection and perinatal outcome in newborns of these women. However, prematurity situations, hospitalization in the NICU, low birth weight, intrauterine growth restriction associated with the mother´s complications, especially preterm rupture of amniotic membranes and UTI, are factors that can increase the risk of infection to these infants [21,22].…”

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

“…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].…”