Pregnancy Outcomes in Women with Sickle Cell Disease (SCD): A Tertiary Centre Retrospective Study in Nigeria

Abstract

Background: Sickle cell disease is the most common inherited condition. Due to recent advances in medical care for patients with sickle cell anaemia, more women with SCD are able to survive up to the reproductive age group. This has given rise to a higher number of pregnant women with SCD. It results in increased fetal and maternal risks due to the metabolic demands, hypercoagulable state and vascular stasis often associated with pregnancy. It has therefore become imperative to explore what progress has been made over the last decade as well as what can be done to achieve the best outcome in these women. 
 Methods: This was a retrospective study of women with SCD who accessed antenatal care (ANC) at the Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi over a ten year period. Folder numbers were obtained from the obstetrics clinic and thereafter the folders were assessed and data retrieved using a checklist. Data analysis was done using SPSS 24.
 Results: The prevalence of sickle cell disease among pregnant women in this centre was 0.03%. All the women had the HbSS variants. The mean age of the subjects was 28.3 ± 5.6years. Majority of the women were gainfully employed. The mean gestational age at booking was 26 9.5 weeks. Half of the neonates had fetal distress at birth. Commonest maternal complication was anemia (100%) followed by vaso-occlusive crisis (89%). Eighty nine percent of the women were delivered by emergency caesarean section prior to 37 weeks gestational age. Preterm birth and fetal distress were the commonest neonatal complications.
 Conclusion: The study revealed that pregnancy associated with sickle cell disease still carries high maternal and fetal morbidity in this environment. Majority of the women with SCD in pregnancy did not receive preconception care and also did not commence their ANC early enough. There is need to educate women with SCD on the need for preconception care to ensure optimization of health prior to conception. They should also book early enough to facilitate close fetal monitoring throughout pregnancy.