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Byams VR, Beckman MG, Grant AM, Parker CS. Developing a public health research agenda for women with blood disorders. J Womens Health (Larchmt) 2011; 19:1231-4. [PMID: 20575677 DOI: 10.1089/jwh.2010.2127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bleeding and clotting in women is an issue that directly affects the life of every woman, child, and family worldwide. This article summarizes recent activities undertaken by the Division of Blood Disorders (DBD) at the Centers for Disease Control and Prevention (CDC) to identify risk factors through evidence-based research and surveillance to prevent complications of blood disorders in women. Specific focus is given to our efforts to improve early identification and diagnosis of blood disorders among women, improve our understanding of maternal and infant outcomes, and develop surveillance systems to monitor the prevalence and incidence of these events.
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Affiliation(s)
- Vanessa R Byams
- Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Causes and mechanisms of intrauterine hypoxia and its impact on the fetal cardiovascular system: a review. Int J Pediatr 2010; 2010:401323. [PMID: 20981293 PMCID: PMC2963133 DOI: 10.1155/2010/401323] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 08/04/2010] [Accepted: 09/16/2010] [Indexed: 11/17/2022] Open
Abstract
Until today the role of oxygen in the development of the fetus remains controversially discussed. It is still believed that lack of oxygen in utero might be responsible for some of the known congenital cardiovascular malformations. Over the last two decades detailed research has given us new insights and a better understanding of embryogenesis and fetal growth. But most importantly it has repeatedly demonstrated that oxygen only plays a minor role in the early intrauterine development. After organogenesis has taken place hypoxia becomes more important during the second and third trimester of pregnancy when fetal growth occurs. This review will briefly adress causes and mechanisms leading to intrauterine hypoxia and their impact on the fetal cardiovascular system.
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Ngô C, Kayem G, Habibi A, Benachi A, Goffinet F, Galactéros F, Haddad B. Pregnancy in sickle cell disease: maternal and fetal outcomes in a population receiving prophylactic partial exchange transfusions. Eur J Obstet Gynecol Reprod Biol 2010; 152:138-42. [DOI: 10.1016/j.ejogrb.2010.05.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 03/03/2010] [Accepted: 05/25/2010] [Indexed: 11/24/2022]
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Chase AR, Sohal M, Howard J, Laher R, McCarthy A, Layton DM, Oteng-Ntim E. Pregnancy outcomes in sickle cell disease: a retrospective cohort study from two tertiary centres in the UK. Obstet Med 2010; 3:110-2. [PMID: 27579072 DOI: 10.1258/om.2010.100026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2010] [Indexed: 11/18/2022] Open
Abstract
The objective of this retrospective cohort study from two tertiary centres in the UK was to describe the pregnancy outcomes of women with sickle cell disease (SCD) who booked at these centres between 2004 and 2008, and to compare this with historical data. The study population comprised 122 singleton pregnancies in women with SCD: homozygous sickle cell disease 64, sickle cell haemoglobin C disease 45, sickle b plus thalassaemia 11, sickle cell haemoglobin E disease 1 and sickle cell delta disease 1 from 2004 to 2008 managed in the joint haematology/obstetric antenatal clinics in two tertiary teaching hospitals. The main outcome measures were the frequency of sickle cell crises and obstetric complications. Age and gestation at booking were 18-43 years (mean 29.7) and 9-36 weeks gestation (mean 17.3), respectively. Complications of SCD occurred in 25% of pregnancies. Fifty-four percent of women had induction of labour and 39% were delivered by emergency caesarean section. Thirty-three percent had a postpartum haemorrhage. Nineteen percent of women delivered before 37 completed weeks. Birth weight below 2500 g occurred in 20% of singleton pregnancies. Three neonates developed transient complications related to maternal opiate exposure postnatally. Three intrauterine deaths occurred at 24, 29 and 34 weeks. Two of these had congenital defects, and the other severe intrauterine growth restriction. No maternal deaths occurred. Successful pregnancy outcomes can be achieved in SCD. There has been an improvement in fetal and maternal morbidity and mortality compared with historical data. Pregnancy in women with SCD remains high risk. Early access to antenatal care and to expertise in SCD is essential. A matched control population from the same time period and prospective data collection is needed to address confounders such as ethnicity and deprivation.
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Affiliation(s)
- A R Chase
- Women's Health Department, Guy's and St Thomas' Hospital NHS Foundation Trust
| | - M Sohal
- Department of Haematology, Imperial College Healthcare NHS Trust
| | - J Howard
- Department of Haematology, Guy's and St Thomas' Hospital NHS Foundation Trust (GSTFT)
| | - R Laher
- King's College London School of Medicine
| | - A McCarthy
- Department of Obstetrics, Queen Charlotte's and Chelsea Hospital (QCCH) , London , UK
| | - D M Layton
- Department of Haematology, Imperial College Healthcare NHS Trust
| | - E Oteng-Ntim
- Women's Health Department, Guy's and St Thomas' Hospital NHS Foundation Trust
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Mousa SA, Abbdulkareem Al Momen, Faisal Al Sayegh, Soad Al Jaouni, Nasrullah Z, Hussein Al Saeed, Alabdullatif A, Mohamad Al Sayegh, Hazaa Al Zahrani, Hegazi M, Amin Al Mohamadi, Alsulaiman A, Omer A, Salam Al Kindi, Tarawa A, Fahad Al Othman, Qari M. Review: Management of Painful Vaso-Occlusive Crisis of Sickle-Cell Anemia: Consensus Opinion. Clin Appl Thromb Hemost 2010; 16:365-76. [PMID: 20530056 DOI: 10.1177/1076029609352661] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Sickle-cell disease (SCD) is a wide-spread inherited hemolytic anemia that is due to a point mutation, leading to the substitution of valine for glutamic acid, causing a spectrum of clinical manifestations in addition to hemolysis and anemia. Acute painful crisis is a common sequela that can cause significant morbidity and negatively impact the patient’s quality of life. Remarkable improvements in the understanding of the pathogenesis of this clinical syndrome and the role of cell adhesion, inflammation, and coagulation in acute painful crisis have led to changes in the management of pain. Due to the endemic nature of SCD in various parts of the Middle East, a group of physicians and scientists from the United States and Middle East recently met to draw up a set of suggested guidelines for the management of acute painful crisis that are reflective of local and international experience. This review brings together a detailed etiology, the pathophysiology, and clinical presentation of SCD, including the differential diagnoses of pain associated with the disease, with evidence-based recommendations for pain management and the potential impact of low-molecular-weight heparin (LMWH), from the perspective of physicians and scientists with long-term experience in the management of a large number of patients with SCD.
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Affiliation(s)
- Shaker A. Mousa
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Abbdulkareem Al Momen
- King Saud University College of Medicine, Department of Medicine, Hematology Oncology Division, Riyadh, Saudi Arabia
| | | | - Soad Al Jaouni
- King Saud University College of Medicine, Department of Medicine, Hematology Oncology Division, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Maha Hegazi
- King Saud University College of Medicine, Department of Medicine, Hematology Oncology Division, Riyadh, Saudi Arabia
| | - Amin Al Mohamadi
- King Saud University College of Medicine, Department of Medicine, Hematology Oncology Division, Riyadh, Saudi Arabia
| | - A. Alsulaiman
- King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Awad Omer
- Security Forces Hospital, Riyadh, Saudi Arabia
| | | | - Ahamd Tarawa
- Madina Maternity and Children's Hospital, Madina, Saudi Arabia
| | | | - Mohammad Qari
- College of Medicine King Abdul-Aziz University, Jeddah, Saudi Arabia
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Yu CKH, Stasiowska E, Stephens A, Awogbade M, Davies A. Outcome of pregnancy in sickle cell disease patients attending a combined obstetric and haematology clinic. J OBSTET GYNAECOL 2010; 29:512-6. [DOI: 10.1080/01443610903003175] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barfield WD, Barradas DT, Manning SE, Kotelchuck M, Shapiro-Mendoza CK. Sickle cell disease and pregnancy outcomes: women of African descent. Am J Prev Med 2010; 38:S542-9. [PMID: 20331956 DOI: 10.1016/j.amepre.2009.12.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/16/2009] [Accepted: 12/22/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a severe hematologic condition that presents unique complications among affected pregnant women. Many studies of adverse perinatal outcomes associated with SCD are limited by small samples or fail to consider important risk factors. PURPOSE This study compared perinatal outcomes among women of African ancestry with and without SCD in a large, population-based sample. METHODS Data from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System were analyzed during June-August 2009 to identify in-state deliveries to resident women of African descent. Logistic regression analyses compared perinatal outcomes for deliveries among women with and without SCD, adjusted for maternal age, education, parity, plurality, insurance status, adequacy of prenatal care, smoking during pregnancy, and infant gender. RESULTS During 1998-2006, there were 116,076 deliveries to 84,561 women; SCD prevalence was 0.6%. Adjusted odds of fetal death among deliveries to women with SCD were 2.2 times those among women without SCD (95% CI=1.2, 4.2). Compared to women without SCD, the odds of preterm delivery, low birth weight, and having babies small for gestational age (SGA) among women with SCD were 1.5 (95% CI=1.2, 1.8); 1.7 (95% CI=1.1, 2.6); and 1.3 (95% CI=1.0, 1.7), respectively. Sickle cell disease was positively associated with cesarean delivery and inductions. CONCLUSIONS Population-based linked data systems are useful for assessing risks of adverse health outcomes among women with specific medical conditions, such as SCD. Women with SCD should seek preconception care to identify and modify risk behaviors and receive counseling regarding potential adverse sequelae associated with pregnancy-related morbidity and preterm delivery.
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Affiliation(s)
- Wanda D Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia 30341, USA.
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Okunlola MA, Olutayo AA, Okonkwo NS, Akingbola TS. Pattern of contraceptive use among women with sickle cell disease in Ibadan, South-west Nigeria. J OBSTET GYNAECOL 2010; 30:171-4. [DOI: 10.3109/01443610903452799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Motta S, Perseghin P, Consonni S, Regalia AL, Masera N. A Case Report of a Successful Monochorionic Diamniotic Twin Pregnancy in a Patient Affected by Sickle Cell Disease Treated With Erythrocytapheresis. Ther Apher Dial 2010; 14:112-5. [DOI: 10.1111/j.1744-9987.2009.00712.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Sickle cell disease (SCD) is a wide-spread inherited hemolytic anemia that is due to a point mutation leading to a valine/glutamic acid substitution in the beta-globin chain, causing a spectrum of clinical manifestations in addition to hemolysis and anemia. Acute painful crisis is a common sequela that can cause significant morbidity and negatively impact the patient's quality of life. Remarkable improvements in our understanding of the pathogenesis of this clinical syndrome and the role of cell adhesion, inflammation, and coagulation in acute painful crisis have led to changes in the management of pain. Due to the endemic nature of SCD in various parts of the Middle East, a group of physicians and scientists from the United States and Middle East recently met to draw up a set of suggested guidelines for the management of acute painful crisis that are reflective of local and international experience. This chapter brings together a detailed etiology, pathophysiology, and clinical presentation of SCD, including the differential diagnoses of pain associated with the disease, with evidence-based recommendations for pain management and the potential impact of low-molecular weight heparin (LMWH), from the perspective of physicians and scientists with long-term experience in the management of a large number of SCD patients.
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Affiliation(s)
- Shaker A Mousa
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA
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Afolabi BB, Iwuala NC, Iwuala IC, Ogedengbe OK. Morbidity and mortality in sickle cell pregnancies in Lagos, Nigeria: A case control study. J OBSTET GYNAECOL 2009; 29:104-6. [DOI: 10.1080/01443610802667112] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chanelles O, Koskas M, Chitrit Y, Riehl-Duvinage C, Saint-Leger S. Hemoglobin S-C disease and fetal well-being: a case report. J Matern Fetal Neonatal Med 2009; 22:465-8. [PMID: 19530008 DOI: 10.1080/14767050802610310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pregnancy outcome in patients with homozygous sickle cell disease in a university hospital, Eastern Saudi Arabia. Arch Gynecol Obstet 2009; 280:793-7. [DOI: 10.1007/s00404-009-1002-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 02/10/2009] [Indexed: 11/26/2022]
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Martí-Carvajal AJ, Peña-Martí GE, Comunián-Carrasco G, Martí-Peña AJ. Interventions for treating painful sickle cell crisis during pregnancy. Cochrane Database Syst Rev 2009; 2009:CD006786. [PMID: 19160301 PMCID: PMC7389073 DOI: 10.1002/14651858.cd006786.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sickle cell disease is a group of genetic haemoglobin disorders. All over the world, about 300,000 children with these disorders are born each year. Acute sickle cell pain episodes are the most common cause of hospitalisation. Pregnancy in women with sickle cell disease is associated with an increased incidence of maternal and fetal morbidity and mortality. The painful crisis is a severe complication of this illness, and it requires several interventions: packed red cell transfusion, fluid replacement therapy, analgesic drugs, oxygen therapy and steroids; but the approach is not standardised. OBJECTIVES To assess the effectiveness and safety of different regimens of packed red cell transfusion, oxygen therapy, fluid replacement therapy, analgesic drugs, and steroids for the treatment of painful sickle cell crisis during pregnancy. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2007), the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register (October 2007), LILACS database (1982 to December 2007) and the following web sites: ClinicalTrials.gov (http://www.clinicaltrials.gov) (December 5, 2007); Current Controlled Trials (http://controlled-trials.com/) (December 5, 2007), and Sistema de Información Esencial en Terapéutica y Salud (http://www.icf.uab.es/informacion/Papyrus/sietes.asp) (December 1, 2007). We also handsearched the European Haematology Association conference (June 2007), the American Society of Hematology conference (December 2007) and reference lists of all retrieved articles. SELECTION CRITERIA We intended to include randomised clinical trials. DATA COLLECTION AND ANALYSIS We intended to summarise data by standard Cochrane Collaboration methodologies. MAIN RESULTS We could not find any randomised clinical trials on interventions (packed red cell transfusion, oxygen therapy, fluid replacement therapy, analgesic drugs, and steroids) for the treatment of painful sickle cell crisis during pregnancy. AUTHORS' CONCLUSIONS This review found no randomised clinical trials on the safety and efficacy of interventions for treating painful sickle cell crisis during pregnancy. The effects of interventions need to be tested in randomised clinical trials.
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Adam S, Jonassaint J, Kruger H, Kail M, Orringer EP, Eckman JR, Ashley-Koch A, Telen MJ, De Castro LM. Surgical and obstetric outcomes in adults with sickle cell disease. Am J Med 2008; 121:916-21. [PMID: 18823864 PMCID: PMC3928637 DOI: 10.1016/j.amjmed.2008.04.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 04/17/2008] [Accepted: 04/27/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sickle cell disease patients are more likely than the general population to undergo surgery and usually do so at a younger age. Female sickle cell disease patients also have special gynecological and obstetric issues related to their disease. METHODS We collected data through standardized clinical report forms, patient interviews, and medical records from 509 adult sickle cell disease patients. Logistic regression was used to estimate the association between multiple variables and each of the surgery types. We also determined the prevalence and outcomes of pregnancy in 284 women with sickle cell disease in this population. RESULTS Almost 50% of patients aged 18-27 years had had a cholecystectomy. Mean corpuscular hemoglobin, total bilirubin, and lactate dehydrogenase were significantly higher in the postcholecystectomy group; 9.5% of 504 individuals had undergone splenectomy. Hematocrit, body mass index, and red blood cell count were significantly higher in the postsplenectomy group. Hip replacement had been performed in 9.2% of individuals, with the prevalence increasing as early as the fourth decade and continuing to increase through the sixth decade of life. A history of pregnancy was present in 190 women (67%). Of 410 pregnancies, only 53.9% resulted in live births, 16.6% were voluntarily terminated, and 29.5% were complicated by miscarriage, still birth, or ectopic implantation. CONCLUSIONS Sickle cell disease continues to have a strong effect on the mean age for common surgeries and impacts pregnancy outcomes. We conclude that this population has a unique surgical and obstetric history that should be further studied to provide insight into potentially more effective preventive approaches to end-organ damage.
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Affiliation(s)
- Soheir Adam
- Department of Medicine, Duke University, Durham, North Carolina 27710, USA.
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Villers MS, Jamison MG, De Castro LM, James AH. Morbidity associated with sickle cell disease in pregnancy. Am J Obstet Gynecol 2008; 199:125.e1-5. [PMID: 18533123 DOI: 10.1016/j.ajog.2008.04.016] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 01/16/2008] [Accepted: 04/08/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to identify morbidity that is associated with sickle cell disease (SCD) in pregnancy. STUDY DESIGN The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 2000-2003 was queried for all pregnancy-related discharges with a diagnosis of SCD. RESULTS There were 17,952 deliveries (0.1% of the total) to women with SCD. There were 10 deaths (72.4 per 100,000 deliveries). Cerebral vein thrombosis, pneumonia, pyelonephritis, deep venous thrombosis, transfusion, postpartum infection, sepsis, and systemic inflammatory response syndrome were much more common among women with SCD. They were more likely to undergo cesarean delivery, to experience pregnancy-related complications (such as gestational hypertension/preeclampsia, eclampsia, abruption, antepartum bleeding, preterm labor, and fetal growth restriction), and to have cardiomyopathy or pulmonary hypertension at the time of delivery. CONCLUSION Women with sickle cell disease are at greater risk for morbidity in pregnancy than previously estimated.
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Pregnancy outcomes in systemic sclerosis, primary pulmonary hypertension, and sickle cell disease. Obstet Gynecol 2008; 111:927-34. [PMID: 18378753 DOI: 10.1097/01.aog.0000308710.86880.a6] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Systemic sclerosis, primary pulmonary hypertension, and sickle cell disease are uncommon vasculopathic diseases affecting women. We estimated the nationwide occurrence of pregnancies in women with these conditions and compared pregnancy outcomes to the general obstetric population. METHODS We studied the 2002-2004 Nationwide Inpatient Sample, of the Healthcare Cost and Utilization Project to estimate the number of obstetric hospitalizations and deliveries among women with systemic sclerosis, primary pulmonary hypertension, sickle cell disease, and women in the general population. Pregnancy outcomes included length of hospital stay, hypertensive disorders including preeclampsia, intrauterine growth restriction (IUGR), and cesarean delivery. Multivariable regression analyses were performed using maternal age, race or ethnicity, antiphospholipid antibody syndrome, diabetes mellitus, and renal failure as covariates. RESULTS Of an estimated 11.2 million deliveries, 504 occurred in women with systemic sclerosis, 182 with primary pulmonary hypertension, and 4,352 with sickle cell disease. Systemic sclerosis, was associated with an increased risk of hypertensive disorders including preeclampsia (odds ratio [OR] 3.71, 95% confidence interval [CI] 2.25-6.15), IUGR (OR 3.74, 95% CI 1.51-9.28), and increased length of hospital stay. Primary pulmonary hypertension was associated with an increase in the odds of antenatal hospitalization (OR 4.67, 95% CI 2.88-7.57), hypertensive disorders including preeclampsia (OR 5.62, 95% CI 2.60-12.15) and a substantial increase in length of hospital stay. Sickle cell disease was associated with an increased odds of antenatal hospitalization (OR 5.56 95% CI 5.08-6.09), hypertensive disorders including preeclampsia (OR 1.78, 95% CI 1.48-2.14), and IUGR (OR 2.91, 95% CI 2.16-3.93), with a modest increase in length of hospital stay. CONCLUSION Women with systemic sclerosis, primary pulmonary hypertension, and sickle cell disease have significantly increased rates of adverse pregnancy outcomes, requiring extensive preconceptional counseling about the risks of pregnancy.
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Liebelt EL, Balk SJ, Faber W, Fisher JW, Hughes CL, Lanzkron SM, Lewis KM, Marchetti F, Mehendale HM, Rogers JM, Shad AT, Skalko RG, Stanek EJ. NTP-CERHR expert panel report on the reproductive and developmental toxicity of hydroxyurea. ACTA ACUST UNITED AC 2007; 80:259-366. [PMID: 17712860 DOI: 10.1002/bdrb.20123] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Driss F, Tertian G, Becquemont L, Haddad B, Cynober T, Raphael M, Tchernia G. Prise en charge des grossesses à risque chez les femmes drépanocytaires : intérêt d’une stratégie préventive par des transfusions de globules rouges ou des échanges érythrocytaires automatisés. Transfus Clin Biol 2007; 14:386-92. [DOI: 10.1016/j.tracli.2007.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 10/05/2007] [Indexed: 11/30/2022]
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Abstract
Women with sickle cell anemia are surviving longer and may desire pregnancy. Rare, life-threatening complications of sickle cell anemia, such as acute chest syndrome, may occur at the time of delivery. A 22-year-old woman with sickle cell (HbS/beta+ thalassemia) at 35 weeks of gestation presented with shortness of breath and generalized pain. She was diagnosed with vasoocclusive crisis and acute chest syndrome, managed with exchange transfusion and cesarean delivery, and discharged home with her newborn one week later. Prompt recognition of life-threatening complications of sickle cell anemia in a pregnant woman and collaborative medical and obstetric management are essential to optimize maternal and fetal outcome.
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Affiliation(s)
- Dany Elsayegh
- Department of Medicine, Columbia University College of Physicians and Surgeons, Medical Intensive Care Unit, St. Luke's Hospital MU 316, 1111 Amsterdam Avenue, New York, NY 10025, USA
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Taylor MY, Wyatt-Ashmead J, Gray J, Bofill JA, Martin R, Morrison JC. Pregnancy loss after first-trimester viability in women with sickle cell trait: time for a reappraisal? Am J Obstet Gynecol 2006; 194:1604-8. [PMID: 16635469 DOI: 10.1016/j.ajog.2006.02.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 01/04/2006] [Accepted: 02/15/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the obstetric outcomes and pathologic findings in women with sickle cell trait. STUDY DESIGN In this retrospective case control study, pregnant women with sickle cell trait were studied over a 4-year period (2001-2005). The women who were delivered at > 16 weeks of gestation were compared with a cohort group of subjects with normal hemoglobin levels, and the placentas were sent for pathologic evaluation. RESULTS A total of 180 pregnancies were studied with a like number of control patients. Subjects who had sickle cell trait demonstrated shorter average duration of pregnancy (233 +/- 45 days vs 255 +/- 34 days; P < .001) and lower birth weight (2114 +/- 1093 g vs 2672 +/- 942 g; P < .001). The rate of fetal death was significantly higher among study group patients (3.5% vs 9.7%; P = .015) when compared with the control group. Additionally, in study women, acute ascending amniotic infection and meconium histiocytosis were noted much more frequently. Sickling in the intervillous space and decidual vessels that were not associated with artifactual change was also found among patients sickle cell trait. CONCLUSION Patients with sickle cell trait appear to be at increased risk for fetal loss compared with women with normal hemoglobin levels, and placental abnormalities may play a causal role.
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Affiliation(s)
- Michelle Y Taylor
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Adeyemi AB, Adediran IA, Kuti O, Owolabi AT, Durosimi MA. Outcome of pregnancy in a population of Nigerian women with sickle cell trait. J OBSTET GYNAECOL 2006; 26:133-7. [PMID: 16483970 DOI: 10.1080/01443610500443428] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although variable clinicopathological entities have been documented in sickle cell trait in pregnancy, such information is absent in this environment. This study therefore was aimed at examining the outcome of pregnancy in a population of Nigerian women with sickle cell trait. A prospective analytical study was carried at Ile-Ife, Nigeria comparing morbidities and mortalities between 210 pregnant women with sickle cell trait and 210 women with HbAA. Data were processed using SPSS 11.0 and PEPI packages, and the p value was set at =0.05. There were no significant differences between mothers with sickle cell trait and HbAA in terms of sociodemographic characteristics, the course of labour, deliveries and morbidity patterns. However, mothers with sickle cell trait had significantly fewer attacks of malaria in pregnancy (25.7% compared with 34.8%) and faster recovery of their newborn from birth asphyxia at 1 min (0.9% compared with 4.9%). Sickle cell trait may confer greater resistance to malaria in pregnancy and carries no extra risk to the outcome of pregnancy.
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Affiliation(s)
- A B Adeyemi
- Departments of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Osun State, Nigeria.
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Rajab KE, Issa AA, Mohammed AM, Ajami AA. Sickle cell disease and pregnancy in Bahrain. Int J Gynaecol Obstet 2006; 93:171-5. [PMID: 16563397 DOI: 10.1016/j.ijgo.2006.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Revised: 01/25/2006] [Accepted: 02/01/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the morbidity and outcome of pregnancies complicated by homozygous sickle cell disease (SCD) in Bahrain. METHODS A controlled study was conducted of all the pregnancies of women with SCD who were delivered at Salmaniya Medical Complex and affiliate hospitals in Bahrain between January 1, 1998, and December 31, 2002. RESULTS There were 351 pregnancies with SCD, giving an incidence of 0.67%. The mean+/-S.D. age of women with SCD was 28.8+/-5.7 years. These women, who were mostly from Shia villages, had more spontaneous abortions than the 351 controls (32% and 12%, respectively). Compared with the control group, the mean+/-S.D. number of pregnancies among women with SCD was 5.0+/-1.9 vs. 5.7+/-3.1; birth weight, 2,965+/-540 g vs. 3,457+/-497 g; rate of preterm deliveries, 25.9% vs. 12%; incidence of intrauterine growth restriction, 10% to 13% vs. 4% to 7%; Apgar scores at 1 and 10 min, 8.1+/-0.8 and 8.8+/-0.8; and cesarean section rate, 19.0% vs. 12.7%. There were no differences in the rates of pre-eclampsia, antepartum and postpartum hemorrhage, or stillbirth. There were 4 maternal deaths directly related to SCD complications. Hemoglobin analysis was performed in 86% of the women with SCD. Of these women, 60.6% had homozygous SCD with raised levels of fetal hemoglobin (more than 5% HbF); 9.6% had sickle cell hemoglobin with beta-thalassemia disease; and 1.4% had sickle cell hemoglobin only. Vaso-occlusive crises were the most common cause of hospital admissions during pregnancy (42.2%), while hemolytic and sequestration crises accounted for 28.0% and 0.6% of admissions. CONCLUSION Mortality, morbidity, and perinatal loss are still considerable among women with SCD in Bahrain. To reduce mortality and morbidity, there is a need for a multidisciplinary team able to deal with pregnancy complications due to SCD.
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Affiliation(s)
- K E Rajab
- Department of Obstetrics and Gynecology, College of Medicine and Medical Science, Arabian Gulf University, Bahrain.
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75
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Legardy JK, Curtis KM. Progestogen-only contraceptive use among women with sickle cell anemia: a systematic review. Contraception 2006; 73:195-204. [PMID: 16413850 DOI: 10.1016/j.contraception.2005.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 08/11/2005] [Indexed: 10/25/2022]
Abstract
The use of progestogen-only contraceptives among women with sickle cell anemia has generated concerns about possible hematological and other clinical complications. Based on the literature, we assessed whether use of progestogen-only contraceptives is associated with adverse health effects among women with sickle cell anemia. We searched the MEDLINE database for articles published in peer-reviewed journals between 1966 and September 2004 that were relevant to sickle cell anemia and use of progestogen-only contraceptives. Of the 70 articles identified through the search, 8 met the criteria for this review. These studies did not identify any adverse events or clinically or statistically significant adverse changes in hematological or biochemical parameters associated with the use of progestogen-only contraceptive methods. Six studies suggested that users experienced a decrease in clinical symptoms and less frequent and severe painful crises compared with nonusers. Although data are limited, these studies suggest that progestogen-only contraceptives are safe for women with sickle cell anemia.
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Affiliation(s)
- Jennifer K Legardy
- WHO Collaborating Center in Reproductive Health, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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76
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Abstract
With advances in management, men and women with sickle cell disease are enjoying an improved quality of life well into adulthood, when they may elect to plan a family. Pregnancy has been associated with exacerbation of sickle cell disease and may place women, especially those with sickle cell anemia (HbSS), at an additional risk for obstetric complications. Appropriate management by health care providers familiar with sickle cell diseases and high-risk obstetric care can result in a successful pregnancy for most women with sickle cell disease.
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Affiliation(s)
- Kathryn Hassell
- Colorado Sickle Cell Treatment and Research Center, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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77
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Serjeant GR, Hambleton I, Thame M. Fecundity and pregnancy outcome in a cohort with sickle cell-haemoglobin C disease followed from birth. BJOG 2005; 112:1308-14. [PMID: 16101613 DOI: 10.1111/j.1471-0528.2005.00678.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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, chi2 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.
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Lottenberg R, Hassell KL. An Evidence-Based Approach to the Treatment of Adults with Sickle Cell Disease. Hematology 2005:58-65. [PMID: 16304360 DOI: 10.1182/asheducation-2005.1.58] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The application of evidence-based medicine to the management of adults with sickle cell disease (SCD) is currently primarily driven by clinical expertise and patient preference, as there is a paucity of randomized controlled trial (RCT) data to guide decision-making. A summary of SCD management principles in the areas of health care maintenance, transfusion therapy, treatment and prevention of painful episodes, acute chest syndrome, stroke, renal disease, contraception and pregnancy, and priapism is predominantly based on the authors’ interpretation of available observational studies as well as the opinions of experts in SCD. RCTs impacting current practices address use of hydroxyurea to prevent painful episodes and acute chest syndrome, intensity of pre-operative transfusion, transfusion during pregnancy, and angiotensin-converting enzyme inhibitor therapy for proteinuria, but most issues in adult SCD care have not been rigorously studied and management may not be appropriately extrapolated from pediatric data. While challenging clinical problems need to be addressed by RCTs, there is also the need for development of practice guidelines using formal methodological strategies. This brief review is not a substitute for the process but provides a literature-based approach to making treatment decisions when caring for adults with SCD.
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Affiliation(s)
- Richard Lottenberg
- University of Florida College of Medicine, Box 100277 UFHSC, Gainesville, Florida 32610, USA.
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79
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Abstract
Hemoglobinopathies represent a unique set of genetic disorders. Formerly, many affected individuals did not survive to childbearing age. Affected women now commonly reach childbearing age and desire pregnancy. Successful pregnancy is possible in many cases with carefully coordinated obstetric and medical management. Genetic screening and prenatal diagnosis is an important aspect of prenatal care in these disorders. DNA mutation analysis offers rapid and accurate fetal diagnosis. Pregnancy also offers a unique situation in that cord blood has become a valuable source of stem cells for transplant. This allows the potential role of the unaffected fetus as a donor for affected siblings. In addition, it was proposed that the fetus may be able to act as a donor of stem cells for an affected mother. Despite current screening recommendations,many couples are not aware that they are carriers; it is common for a child to be born with an unexpected, serious hemoglobinopathies. For this reason, newborn screening programs have been introduced in most high-risk areas. Early diagnosis can facilitate implementation of proper preventive health measures, education of the parents regarding their carrier status, and provide the child with ongoing comprehensive care.
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Affiliation(s)
- Valerie J Rappaport
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, University of New Mexico Health Sciences Center, 211 Lomas Blvd NE, ACC-4, Albuquerque, NM 87131, USA.
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Serjeant GR, Loy LL, Crowther M, Hambleton IR, Thame M. Outcome of Pregnancy in Homozygous Sickle Cell Disease. Obstet Gynecol 2004; 103:1278-85. [PMID: 15172865 DOI: 10.1097/01.aog.0000127433.23611.54] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous reports on pregnancy in homozygous sickle cell (SS) disease are biased by hospital-based, more severely affected subjects and may have underestimated recurrent early pregnancy losses. We report pregnancy outcome in a representative sample of SS subjects subsequently referred to as "subjects" or "sickle cell subjects," and matched normal controls followed from birth. METHODS The outcomes of 94 pregnancies in 52 subjects and 157 pregnancies in 68 controls followed in a cohort study from birth are presented. Outcome measures included the age at menarche, interval to first pregnancy, outcome of pregnancy, and maternal complications. Possible predictors of low birth weight are assessed. Outcomes were compared by the Kaplan-Meier analysis for interval to first pregnancy and by Student t test, chi(2) test, or Fisher exact test, as appropriate. Correction was made for multiple testing, and multiple linear regression was used for analysis of birth weight. RESULTS Compared with controls, SS subjects had later menarche (median age 15.4 versus 13.0 years) and first pregnancy (median age 23.7 versus 20.1 years), and more spontaneous abortions (36% versus 10%). Babies of SS subjects had a lower gestational age (P <.001) and lower birth weight (P <.001), the latter being significantly affected by sickle-related events in pregnancy. There was no difference in pregnancy-induced hypertension, preeclampsia, or antepartum or postpartum hemorrhage, but a retained placenta was marginally more common in SS subjects (Fisher exact test, P =.007 after adjustment for multiple testing). Two SS subjects died, a mortality rate of 2.1%. CONCLUSION The increased fetal loss and maternal morbidity in mothers with homozygous sickle cell disease is confirmed. LEVEL OF EVIDENCE II-2
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Affiliation(s)
- Graham R Serjeant
- Sickle Cell Trust (Jamaica) 14 Milverton Crescent, Kingston 6 , Jamaica, West Indies.
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Diop S, Sarr P, Toure-Fall AO, Thiam D, Diakhaté L. Normal delivery is still a challenge during pregnancy in sickle cell disease patients. Ann Hematol 2004; 84:194-5. [PMID: 15042320 DOI: 10.1007/s00277-004-0871-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Accepted: 03/04/2004] [Indexed: 10/26/2022]
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de Montalembert M. [Sickle cell disease in the neonatal period]. ACTA ACUST UNITED AC 2004; 33:S12-4. [PMID: 14968012 DOI: 10.1016/s0368-2315(04)96658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The prognosis of pregnancy in women with major sickle cell syndromes has improved greatly in recent years. Correction of maternal anemia with programmed transfusion has been a major advance. Rates of preterm birth and intra-uterine growth retardation nevertheless remain high in this population. A newborn affected with sickle cell disease does not develop complications of the disease, because the predominant fetal hemoglobin cannot co-polymerize with sickle hemoglobin. The rate of complications increases as the infant's hemoglobin synthesis switches from fetal to sickle hemoglobin. Neonatal screening of sickle cell disease patients enables early implementation of a comprehensive prevention program (daily antibiotic prophylaxy, immunization, parental education.). A neonatal screening program, targeted with regard to the parents' ethnic background, has been implemented throughout metropolitan France since 1999. In 2002, this program enabled early diagnosis of sickle cell disease in 313 newborns.
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Affiliation(s)
- M de Montalembert
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades, Paris.
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