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Adigwe OP, Onavbavba G, Onoja SO. Impact of Sickle Cell Disease on Affected Individuals in Nigeria: A Critical Review. Int J Gen Med 2023; 16:3503-3515. [PMID: 37601802 PMCID: PMC10438428 DOI: 10.2147/ijgm.s410015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/08/2023] [Indexed: 08/22/2023] Open
Abstract
Sickle cell disease is an autosomal recessive disorder of the beta-globin gene, with resultant deformation of the red blood cells and variable clinical outcomes. Nigeria is recognised as the country with the highest burden of sickle cell disease globally. This study aimed at critically reviewing available literature on impact of sickle cell disease in Nigeria. A literature search was carried out on four databases, and a total of 116 articles that met the inclusion criteria were included in the critical review. It was observed that majority of the studies were carried out in South-Western part of Nigeria (47.4%), whilst the North-East had the least number of studies undertaken in this area, more than a quarter of the studies (27.6%) were related to hematologic and serologic screening. Major themes that emerged from this review were morbidity and mortality; prevalence of sickle cell disease; issues relating to blood transfusion; psychosocial impact; and anatomical dysfunction in sickle cell disease. Intervention programs from both government and non-governmental organizations aimed at reducing the burden of sickle cell disease and its socio-economic impact were identified as key to strategies aimed at overcoming challenges associated with the disease. Findings from this study also revealed that education and awareness interventions were central to reducing the prevalence of sickle cell disease in this setting.
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Affiliation(s)
- Obi Peter Adigwe
- National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
| | - Godspower Onavbavba
- National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria
| | - Solomon Oloche Onoja
- Department of Medical Laboratory Sciences, University of Nigeria, Enugu, Nigeria
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Aliyu LD, Kadas AS, Mohammed A, Abdulllahi HM, Farouk Z, Usman F, Attah RA, Yusuf M, Magashi MK, Miko M. Impediments to maternal mortality reduction in Africa: a systemic and socioeconomic overview. J Perinat Med 2023; 51:202-207. [PMID: 35670321 DOI: 10.1515/jpm-2022-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/21/2022] [Indexed: 11/15/2022]
Abstract
Maternal mortality is nowadays more of a problem of developing countries especially those in Sub-Saharan Africa (SSA). Maternal mortality has to large extent been eliminated in developed countries and has drastically been reduced in many other regions of the world. The maternal mortality rate (MMR) available in the literature from Africa is not a true reflection of the actual MMR as it is derived from institutional studies. The causes of maternal mortality in SSA are the same as those in developed countries. The means of addressing maternal mortality used in developed countries are the same as those used in developing countries, however, the success levels are not the same. There are various impediments to reducing maternal mortality with roots in cultural, social, economic and systemic factors prevalent in SSA. An in-depth study of these factors will give an insight as to why maternal mortality reduction has remained an enigma in SSA. Analyzing these factors will guide us to design and implement measures that will in the long run lead to significant maternal mortality reduction in SSA. The aim of this review is to identify impediments to maternal mortality reduction in SSA and highlight measures that can lead to maternal mortality reduction.
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Muacevic A, Adler JR, Mujalda A, Mujalda J, Yadav S, Kundal RK. The Effect of Sickle Cell Hemoglobinopathy on Pregnancy, Labor, Puerperium, and Fetal Outcome: A Retrospective Cohort Study From a Single Centre. Cureus 2023; 15:e34318. [PMID: 36865957 PMCID: PMC9971241 DOI: 10.7759/cureus.34318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a major risk factor as far as pregnancy and obstetric complications are concerned. It possesses major perinatal and postnatal mortality. The management of pregnancy along with SCD requires a multispecialty team consisting of hematologists, obstetricians, anesthesiologists, neonatologists and intensivists. OBJECTIVES The objective of this study was to investigate the effect of sickle cell hemoglobinopathy on pregnancy, labor, puerperium, and fetal outcome in the rural and urban localities of Maharashtra, India. MATERIAL AND METHODS The present study is a comparative retrospective analysis of 225 pregnant women with SCD (genotype AS and SS) and 100 age- and gravida-matched pregnant women with normal hemoglobin (genotype AA) as a control who were treated between June 2013 to June 2015, in Indira Gandhi Government Medical College (IGGMC), Nagpur, India. We analyzed various data regarding obstetrical outcomes and complications in sickle cell disease mothers. RESULTS Out of 225 pregnant women, 38 (16.89%) were diagnosed with homozygous sickle cell disease (SS group) while 187 (83.11%) were diagnosed with sickle cell trait (AS group). The most common antenatal complications were sickle cell crisis (17; 44.74%) and jaundice (15; 39.47%) in the SS group whereas pregnancy-induced hypertension (PIH) was noted in 33 (17.65%) in the AS group. Intrauterine growth restriction (IUGR) was recorded in 57.89% of the SS group and 21.39% of the AS group. A higher chance of emergency lower segment cesarean section (LSCS; 66.67% in the SS group and 79.09% in the AS group) was recorded as compared with the control group at 32%. CONCLUSION In order to minimize risks to the mother and fetus and for better outcomes it is prudent to manage pregnancy with SCD vigilantly in the antenatal period. In the antenatal period mothers with this disease should be screened for hydrops or bleeding manifestations such as intracerebral hemorrhage in the fetus. Better feto-maternal outcomes can be achieved by effective multispecialty intervention.
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Aghamolaei T, Pormehr-Yabandeh A, Hosseini Z, Roozbeh N, Arian M, Ghanbarnezhad A. Pregnancy in the Sickle Cell Disease and Fetomaternal Outcomes in Different Sickle cell Genotypes: A Systematic Review and Meta-Analysis. Ethiop J Health Sci 2022; 32:849-864. [PMID: 35950054 PMCID: PMC9341032 DOI: 10.4314/ejhs.v32i4.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pregnancy is a major concern among women with the sickle cell disease (SCD), and it is associated with increased adverse outcomes. The aim of the present meta-analysis is to report the fetomaternal outcomes in different sickle cell genotypes. Methods In this systematic review and meta-analysis, a comprehensive search of databases and search engines such as PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, Science Direct and Google Scholar were performed. Any observational studies that had compared at least one outcome such as maternal outcomes, fetal outcomes, and morbidity between two groups of pregnant women with different types of sickle cell genotypes and pregnant women without SCD were evaluated. Results A total number of 9,827 pregnant women with SCD were examined. The results showed that pregnancy in SCD increased the risk of adverse outcomes for the mothers (including postpartum hemorrhage, prematurity, pregnancy-induced hypertension, pre-eclampsia, eclampsia, cesarean section, lower segment cesareansection, maternal death), fetus (including live births, low birth weight, intrauterine growth restriction, APGAR score at 5 min <7, stillbirth, neonatal death, perinatal mortality, acute fetal distress, intrauterine fetal death) and morbidity among the SCD(severe anemia, urinary tract infection, blood transfusion, painful crisis, acute chest syndrome, vaso-occlusive crises). Conclusion According to the results of this meta-analysis, pregnancy in the SCD is associated with an increased risk of maternal outcomes, fetal outcomes, and morbidity among SCD patients with different genotypes. Pregnancy in sickle cell hemoglobinopathies needs careful multidisciplinary management and cautious caring so as to decrease maternal and fetal morbidity and mortality.
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Affiliation(s)
- Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Asiyeh Pormehr-Yabandeh
- PhD Student in Health Education and Promotion, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institue, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mahdieh Arian
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Ghanbarnezhad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Aliyu Z, Kushimo OA, Oluwole AA, Amadi C, Oyeyemi N, Mbakwem A, Afolabi BB. Effects of pregnancy on cardiac structure and function in women with sickle cell anemia: a longitudinal comparative study. J Matern Fetal Neonatal Med 2022; 35:10049-10054. [PMID: 35723675 DOI: 10.1080/14767058.2022.2089549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Sickle cell anemia is the commonest hemoglobinopathy in pregnant Nigerian women, and cardiac manifestations are a significant feature of the disease especially in pregnancy. Pregnant women with sickle cell anemia are at high risk of morbidity and mortality and cardiac dysfunction in them increases this risk and may compromise their post-partum health. OBJECTIVE To evaluate the cardiac size and function in women with sickle cell anemia (HbSS) during late pregnancy and postpartum. METHODOLOGY This was a longitudinal comparative study in which 40 women, consisting of 20 pregnant HBSS and 20 pregnant HBAA women controls, were recruited. Echocardiography was performed in the third trimester of pregnancy and 6 weeks postpartum. RESULTS There was a decrease in the mean left atrial diameter (p < .001), left ventricular diameter in diastole (p = .041), and left ventricular mass (p = .004) of HBSS women in the postpartum period compared to their antepartum state. In contrast, there was no significant difference in most cardiac dimensions of pregnant vs postpartum HBAA women. There was no significant change in cardiac function in the pregnant vs postpartum states in both study groups. There were significant differences in cardiac size but not function when comparing HBSS and HBAA women in pregnancy and postpartum. CONCLUSION Changes in cardiac size of sickle cell women in pregnancy does not appear to affect cardiac function during pregnancy and in the puerperium, suggesting that the increased size may purely be a response to their chronic anemic state. Studies following women up for longer periods including those with co-morbidities are recommended.
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Affiliation(s)
- Zubaida Aliyu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oyewole A Kushimo
- Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ayodeji A Oluwole
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Casmir Amadi
- Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Nuvie Oyeyemi
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Amam Mbakwem
- Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Bosede B Afolabi
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
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Figueira CO, Surita FG, Fertrin K, Nobrega GDM, Costa ML. Main Complications during Pregnancy and Recommendations for Adequate Antenatal Care in Sickle Cell Disease: A Literature Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:593-601. [PMID: 35139577 PMCID: PMC9948053 DOI: 10.1055/s-0042-1742314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sickle cell disease (SCD) is the most common monogenic disease worldwide, with a variable prevalence in each continent. A single nucleotide substitution leads to an amino-acid change in the β-globin chain, altering the normal structure ofhemoglobin, which is then called hemoglobin S inherited in homozygosity (HbSS) or double heterozygosity (HbSC, HbSβ), and leads to chronic hemolysis, vaso-occlusion, inflammation, and endothelium activation. Pregnant women with SCD are at a higher risk of developing maternal and perinatal complications. We performed a narrative review of the literature considering SCD and pregnancy, the main clinical and obstetrical complications, the specific antenatal care, and the follow-up for maternal and fetal surveillance. Pregnant women with SCD are at a higher risk of developing clinical and obstetric complications such as pain episodes, pulmonary complications, infections, thromboembolic events, preeclampsia, and maternal death. Their newborns are also at an increased risk of developing neonatal complications: fetal growth restriction, preterm birth, stillbirth. Severe complications can occur in patients of any genotype. We concluded that SCD is a high-risk condition that increases maternal and perinatal morbidity and mortality. A multidisciplinary approach during pregnancy and the postpartum period is key to adequately diagnose and treat complications.
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Affiliation(s)
| | | | - Kleber Fertrin
- Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, United States
| | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Afolabi BB, Babah OA, Adeyemo TA, Odukoya OO, Ezeaka CV, Nwaiwu O, Oshodi YA, Ogunnaike BA. Low-dose aspirin for preventing intrauterine growth restriction and pre-eclampsia in sickle cell pregnancy (PIPSICKLE): a randomised controlled trial (study protocol). BMJ Open 2021; 11:e047949. [PMID: 34389570 PMCID: PMC8365818 DOI: 10.1136/bmjopen-2020-047949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pregnancy in sickle cell disease is fraught with many complications including pre-eclampsia (PE) and intrauterine growth restriction (IUGR). Previously, we found an abnormality in prostacyclin-thromboxane ratio in sickle cell pregnant women, a situation that is also found in non-sickle pregnancies with PE and unexplained IUGR. Low-dose aspirin (LDA) has been shown to reduce the incidence of PE and IUGR in high-risk women by reducing the vasoconstrictor thromboxane while sparing prostacyclin, in effect 'correcting' the ratio. It has been found to be safe for use in pregnancy but has not been tested in sickle cell pregnancy. We hypothesise that LDA will reduce the incidence of IUGR and PE in pregnant haemoglobin SS (HbSS) and haemoglobin SC (HbSC) women. METHODS AND ANALYSIS This is a multisite, double blind, randomised controlled trial, comparing a daily dose of 100 mg aspirin to placebo, from 12 to 16 weeks' gestation until 36 weeks, in Lagos state, Nigeria. Four hundred and seventy-six eligible pregnant HbSS and HbSC women will be recruited consecutively, randomly assigned to either group and followed from recruitment until delivery. The primary outcome will be the incidence of birth weight below 10th centile for gestational age on INTERGROWTH 21 birth weight charts, or incidence of miscarriage or perinatal death. Secondary outcomes will include PE, maternal death, preterm delivery, perinatal death, number of crises, need for blood transfusion and complications such as infections and placental abruption. Analysis will be by intention to treat and the main treatment effects will be quantified by relative risk with 95% CI, at a 5% significance level. ETHICAL APPROVAL Ethical approval has been granted by the Health Research and Ethics committees of the recruiting hospitals and the National Health Research and Ethics Committee. Study findings will be presented at conferences and published appropriately. TRAIL REGISTRATION NUMBER PACTR202001787519553; Pre-results.
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Affiliation(s)
- Bosede Bukola Afolabi
- Obstetrics and Gynaecology, University of Lagos College of Medicine, Idi-Araba, Lagos, Nigeria
| | - Ochuwa Adiketu Babah
- Obstetrics and Gynaecology, University of Lagos College of Medicine, Idi-Araba, Lagos, Nigeria
| | - Titilope Adenike Adeyemo
- Haematology and Blood Transfusion, University of Lagos College of Medicine, Idi-Araba, Lagos, Nigeria
| | | | | | - Obinyo Nwaiwu
- Pharmacology, University of Lagos College of Medicine, Idi-Araba, Lagos, Nigeria
| | - Yusuf Abisowo Oshodi
- Obstetrics & Gynaecology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
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8
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Muniz JG, Arnoni C, Medeiros R, Vendrame T, Cortez A, S Afonso J, Latini F, Castilho L, Girão M. Antigen matching for transfusion support in Brazilian female patients with sickle cell disease to reduce RBC alloimmunization. Transfusion 2021; 61:2458-2467. [PMID: 34121200 DOI: 10.1111/trf.16544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Red blood cell (RBC) alloimmunization is a complication of patients with sickle cell disease (SCD) and it has a greater impact on pregnancy, leading to a risk of hemolytic disease of the newborn and reducing blood availability for pregnant women. This study proposed to evaluate antigen matching transfusion protocols, aiming to reduce RBC alloimmunization in Brazilian female patients with SCD. METHODS Samples from female patients with SCD (153) and self-declared Afro-Brazilian donors (307) were genotyped for RBC antigens and RH variants were investigated. The transfusion needs of patients during 1-year period and the number of compatible donors were assessed using three antigen-matching transfusion protocols: prophylactic CEK antigen-matched RBCs, prophylactic extended antigen-matched RBCs, and extended-matched red blood cells (RBCs) only for alloimmunized patients. In addition, RH molecular matching has been proposed for patients carrying variant RHCE. RESULTS Provision of CEK antigen-matched donors would have been possible in 92.4% of transfusion events while provision of prophylactic extended antigen-matched RBCs would cover 88.7% of the transfusion events. Extended antigen matching for alloimmunized patients would be efficient in 99% of the cases. The presence of partial D in 10 patients increased the need of D-negative donors. Compatible donors could be enough for four of the five patients with altered RHCE genotypes in both alleles. CONCLUSION In Brazilians, screening African descent donors allows the implementation of prophylactic CEK and extended antigen-matching transfusion protocols to female patients with SCD to reduce RBC alloimmunization; however, the supply of compatible blood can be impaired for patients with Rh variants.
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Affiliation(s)
- Janaína Guilhem Muniz
- Technical and Scientific Department, Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
| | - Carine Arnoni
- Technical and Scientific Department, Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
| | - Rosangela Medeiros
- Technical and Scientific Department, Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
| | - Tatiane Vendrame
- Technical and Scientific Department, Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
| | - Afonso Cortez
- Technical and Scientific Department, Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
| | - José S Afonso
- Departamento de Ginecologia, Unifesp (Universidade Federal de São Paulo), São Paulo, Brazil.,Department of Gynecology, UEA - University of the State of Amazonas, Brazil
| | - Flavia Latini
- Technical and Scientific Department, Colsan-Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
| | - Lilian Castilho
- Hemocentro Campinas, University of Campinas - Unicamp, Campinas, Brazil
| | - Manoel Girão
- Departamento de Ginecologia, Unifesp (Universidade Federal de São Paulo), São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW Pregnancy exacerbates sickle cell disease (SCD) and is associated with increased frequency and severity of complications resulting in high levels of maternal and fetal morbidity and mortality. We review recent recommendations for managing SCD in pregnancy. RECENT FINDINGS An updated pathobiological model of SCD now attributes the clinical picture to a vicious cycle of four major cellular disturbances. Management decisions should be guided by an understanding of this upgraded model. Red cell transfusions are a key therapeutic intervention used in managing several acute and chronic complications. Transfusion however has significant drawbacks. The American Society of Hematology recently published transfusion guidelines to support care providers. SUMMARY Patients should be managed by a multidisciplinary and experienced team. The perioperative episode is a recognized period of disease exacerbation and informed anesthetic management can contribute to improved patient outcomes.
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Affiliation(s)
- Ada Ezihe-Ejiofor
- Department of Anaesthesia, Guys & St Thomas's Hospital NHS Foundation Trust, London, UK
| | - Jaleesa Jackson
- Department of Anaesthesia, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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10
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Lewis G, Thame M, Howitt C, Hambleton I, Serjeant GR. Pregnancy outcome in homozygous sickle cell disease: observations from the Jamaican Birth Cohort. BJOG 2021; 128:1703-1710. [PMID: 33683802 DOI: 10.1111/1471-0528.16696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To document pregnancy outcome in homozygous sickle cell (SS) disease and in age-matched controls with a normal haemoglobin genotype followed from birth for up to 45 years. METHODS A total of 100 000 consecutive non-operative deliveries screened for sickle cell disease at the main Government maternity hospital in Kingston, Jamaica between 1973 and 1981 detected 311 (149 female) babies with SS disease who were matched by age and gender with 250 (129 female) controls with an AA haemoglobin phenotype. These individuals have been followed from birth with prospective assessment of menarche and detailed documentation of all pregnancies. RESULTS There were 177 pregnancies in 71 SS patients and 226 pregnancies in 74 AA controls. Mothers with SS disease had more spontaneous abortions (adjusted relative risk [aRR] 3.2, 95% CI 1.6-6.1), fewer live births (aRR 0.7, 95% CI 0.6-0.9) and their offspring were more likely to have a gestational age <37 weeks (aRR 2.1, 95% CI 1.1-3.7) and low birthweight <2.5 kg (aRR 3.0, 95% CI 1.6-5.3). They were more prone to acute chest syndrome (aRR 13.7, 95% CI 4.1-45.5), urinary tract infection (aRR 12.8, 95% CI 1.3-125.9), pre-eclampsia/eclampsia (aRR 3.1, 95% CI 1.1-8.8), retained placenta (aRR 10.1, 95% CI 1.1-90.3), sepsis (Fisher's Exact test 0.04) and pregnancy-related deaths (Fisher's Exact test 0.02). Four of five deaths were attributable to acute chest syndrome. There was no genotypic difference in pregnancy-induced hypertension or postpartum haemorrhage. CONCLUSION Pregnancy in SS disease carries risks for both mother and child. The variable characteristics of pregnancy-related deaths complicate their prevention. TWEETABLE ABSTRACT Pregnancy in SS disease compared with controls showed increased abortions and stillbirths, fewer live births and maternal deaths in 7% patients.
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Affiliation(s)
- G Lewis
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - M Thame
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - C Howitt
- Sir George Alleyne Chronic Disease Research Centre, The University of the West Indies, Cave Hill, Bridgetown, Barbados
| | - I Hambleton
- Sir George Alleyne Chronic Disease Research Centre, The University of the West Indies, Cave Hill, Bridgetown, Barbados
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Swarray-Deen A, Nkyekyer K, Seffah JD, Mumuni K, Mensah-Brown SA, Tuuli MG, Oppong SA. Cerebro-placental ratio as a prognostic factor of fetal outcome in pregnancy complicated by maternal sickle cell disease. Int J Gynaecol Obstet 2020; 150:248-253. [PMID: 32415985 DOI: 10.1002/ijgo.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/31/2020] [Accepted: 05/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess the role of the cerebro-placental ratio (CPR) in predicting adverse fetal outcomes among women with sickle cell disease (SCD). METHODS A prospective cohort study at Korle-Bu Teaching Hospital, Accra, Ghana, between January and June 2016. Pregnant women with SCD at 34 gestational weeks or more underwent weekly fetal umbilical and middle cerebral artery Doppler assessment until delivery. Participants were categorized into two study arms based on CPR (<1.1 or ≥1.1). The primary outcome, a composite of adverse perinatal outcomes including intrauterine growth restriction, stillbirth, low birthweight, and neonatal intensive care unit admission, was compared between groups. RESULTS Overall, 48 pregnant women with SCD were enrolled, and 5 had a fetus with CPR less than 1.1. Low CPR (<1.1) had a sensitivity and specificity of 29.4% and 100%, respectively, for predicting composite adverse perinatal outcomes. Sensitivity and specificity were, respectively, 100% and 93.5% for predicting stillbirth, and 40.2% and 97.4% for predicting low birthweight. Perinatal outcomes did not differ between the two major sickle cell genotypes (hemoglobin SS and hemoglobin SC). CONCLUSIONS Among women with SCD, CPR less than 1.1 was associated with adverse perinatal outcomes, particularly low birthweight and stillbirth.
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Affiliation(s)
- Alim Swarray-Deen
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Kobinah Nkyekyer
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Joseph D Seffah
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Kareem Mumuni
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | | | - Methodius G Tuuli
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samuel A Oppong
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
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12
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Bae E, Tangel V, Liu N, Abramovitz SE, White RS. Inpatient mortality and postpartum readmission rates in sickle cell disease pregnancies: a multistate analysis, 2007-2014. J Matern Fetal Neonatal Med 2019; 34:2783-2792. [PMID: 31588827 DOI: 10.1080/14767058.2019.1671333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We compared post-partum outcomes between sickle cell disease (SCD) and non-sickle cell populations. METHODS We conducted a retrospective analysis of discharge data for 6,911,916 inpatient deliveries in the states of California, Florida, New York, Maryland, and Kentucky from 2007 to 2014 using data from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared unadjusted rates and adjusted odds of 30- and 90-d readmission rates, in-hospital mortality, length of stay (LOS), and total hospital charges in SCD, sickle cell trait, and non-sickle cell patients. RESULTS Compared to non-sickle cell patients, SCD patients were more than two times as likely to die in-hospital (aOR: 2.16, 95% CI: 1.15-4.04, p < .05), 27% as likely to be readmitted up to 30 d postdelivery (aOR: 1.27, 95% CI: 1.13-1.43, p < .001), and 92% as likely to be readmitted up to 90 d postdelivery (aOR 1.92, 95% CI: 1.75-2.11, p < .001). The SCD group also had a longer median LOS, greater total hospital charges, were more likely to experience a postpartum complication, and receive a blood transfusion than the non-SCD group. CONCLUSIONS SCD in pregnancy is associated with increased inpatient mortality, readmissions, postpartum complications, LOS, and hospital charges.
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Affiliation(s)
- Evelyn Bae
- Department of Anesthesiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Virginia Tangel
- Department of Anesthesiology, Center for Perioperative Outcomes, Weill Cornell Medicine, New York, NY, USA
| | - Nathan Liu
- Department of Anesthesiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Sharon E Abramovitz
- Department of Anesthesiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Robert S White
- Department of Anesthesiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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Zamané H, Sanou F, Kiemtoré S, Kain DP, Sawadogo AK, Bonané-Thiéba B. Transfusion practices in the care of pregnant women with sickle cell disease in Ouagadougou. Int J Gynaecol Obstet 2019; 147:363-367. [PMID: 31489626 DOI: 10.1002/ijgo.12961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/24/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To study the contribution of blood transfusion management in the improvement of maternal and perinatal outcomes in pregnant women with sickle cell disease in Ouagadougou. METHODS A cross-sectional retrospective study with data collected from February 2012 to January 2014 was used. Patients were differentiated into three groups: patients with at least one exchange transfusion, patients who received blood transfusion, and patients who did not receive any transfusion. Data were collected from patients' patient care documents. RESULTS One hundred and sixty-four patients were included, of whom 53 were in the first group, 32 in the second group, and 79 in the third group. Maternal complications in the last trimester of pregnancy were significantly less important (P=0.000) in the first group (58.5%) than in the second (78.5%) and third group (91.1%). The same trend was observed for postpartum maternal mortality (5.7%; 12.5%; 12.6%; P=0.009). Fetal complications such as preterm birth and early neonatal death were lower in the first group (15.1%; 1.8%) than in the second (40.6%; 23.1%) and third group (32.9%; 7.6%). CONCLUSION Prophylactic blood transfusion is an important part of the management of pregnant patients with sickle cell disease.
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Affiliation(s)
- Hyacinthe Zamané
- Department of Gynecology and Obstetrics, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso.,University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Fabienne Sanou
- Department of Oncology and Hematology, Bogodo District Hospital, Ouagadougou, Burkina Faso
| | - Sibraogo Kiemtoré
- Department of Gynecology and Obstetrics, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso.,University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Dantola Paul Kain
- Department of Gynecology and Obstetrics, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso.,University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | | | - Blandine Bonané-Thiéba
- Department of Gynecology and Obstetrics, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso.,University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso
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14
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Nugent WH, Jubin R, Buontempo PJ, Kazo F, Song BK. Microvascular and systemic responses to novel PEGylated carboxyhaemoglobin-based oxygen carrier in a rat model of vaso-occlusive crisis. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:95-103. [DOI: 10.1080/21691401.2018.1543197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Ronald Jubin
- Prolong Pharmaceuticals, South Plainfield, NJ, USA
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Agbaje OA, Adeyomoye AAO, Omidiji OAT, Oboke OS, Afolabi BB. Evaluation of Umbilical Artery Doppler Indices in Pregnant Women With Sickle Cell Anemia Disease at a Nigerian Tertiary Hospital. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318791157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pregnant patients with sickle cell anemia (HbSS) are at risk of adverse outcomes to the mother and the fetus due to unique pathophysiologic changes. The purpose of this study was to determine the umbilical artery (UA) Doppler indices at 26 weeks gestational age (GA) in HbSS women with uncomplicated pregnancies and compare with the obstetric outcome. In this cohort study, 60 HbSS and 60 normal hemoglobin (HbAA) women with uncomplicated pregnancies were recruited from the antenatal clinic and prospectively followed to delivery. UA velocimetry, fetal biometry, maternal hematocrit, and parity were assessed at 26 weeks. Fetomaternal outcomes were also documented. UA Doppler indices and estimated fetal weights were comparable to those of HbAA control subjects at 26 weeks GA. There was a statistically significant increase in adverse obstetric outcomes in HbSS patients. There was no correlation between maternal hematocrit and artery indices. Further research is required to determine cutoff values and optimal timing for sonography in HbSS patients.
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Affiliation(s)
| | - Adekunle Ayokunle Olakunle Adeyomoye
- Department of Radiation Biology, Radiotherapy, Radiodiagnosis and Radiography, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olubukola Abeni Titilayo Omidiji
- Department of Radiation Biology, Radiotherapy, Radiodiagnosis and Radiography, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Ozoemena S. Oboke
- Department of Radiology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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McCaw-Binns AM, Campbell LV, Spence SS. The evolving contribution of non-communicable diseases to maternal mortality in Jamaica, 1998-2015: a population-based study. BJOG 2018; 125:1254-1261. [PMID: 29419921 DOI: 10.1111/1471-0528.15154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To describe trends in indirect cause-specific pregnancy-related mortality from 1998 to 2015. DESIGN Secondary analysis of annual, national cross-sectional database of maternal and late maternal deaths, identified through active surveillance of deaths among women aged 10-50 years. SETTING Jamaica, a middle-income Caribbean country. POPULATION Maternal and late maternal deaths. METHODS Descriptive trend analyses of demographic and cause-specific maternal and pregnancy-related mortality ratios undertaken comparing the periods 1998-2003, 2004-2009 and 2010-2015. Multivariate logistic regression was used to confirm changes in risk of indirect death. MAIN OUTCOME MEASURES Maternal, pregnancy-related, direct, indirect and cause-specific mortality ratios (deaths/100 000 live births). RESULTS Maternal deaths from indirect conditions increased between the first two periods (P = 0.004) and stabilised in the third (P = 0.085). Associated with upward movement in cardiovascular deaths (P[trend] = 0.003), women under 25 years were at elevated risk (odds ratio 1.44, 95% CI 1.00-2.08; P = 0.052). Haematological/immunological conditions (69% sickle cell disease) ranked second but did not vary with time. Health service utilisation was similar across age, parity, health region and major cause categories (non-communicable diseases, non-obstetric infections, direct), however women with indirect conditions spent more time in hospital (median 5 days versus 3 days) and more often died after the puerperium. CONCLUSIONS Medical conditions, especially cardiovascular disease, are increasingly associated with maternal and late maternal mortality. Middle-income countries need to simultaneously improve management of indirect conditions, while redoubling efforts to reduce direct deaths. Postpuerperal medical services should be integrated into routine infant health services to improve continuity of care during this high-risk period. TWEETABLE ABSTRACT Maternal survival (SDG 3.1) in LMICs requires better care for women with both non-communicable diseases and obstetric conditions.
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Affiliation(s)
- A M McCaw-Binns
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica
| | - L V Campbell
- Department of Obstetrics and Gynaecology, Victoria Jubilee Hospital, Ministry of Health, Kingston, Jamaica
| | - S S Spence
- Family Health Unit, Ministry of Health, Kingston, Jamaica
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Ribeil J, Labopin M, Stanislas A, Deloison B, Lemercier D, Habibi A, Albinni S, Charlier C, Lortholary O, Lefrere F, De Montalembert M, Blanche S, Galactéros F, Tréluyer J, Gluckman E, Ville Y, Joseph L, Delville M, Benachi A, Cavazzana M. Transfusion-related adverse events are decreased in pregnant women with sickle cell disease by a change in policy from systematic transfusion to prophylactic oxygen therapy at home: A retrospective survey by the international sickle cell disease observatory. Am J Hematol 2018; 93:794-802. [PMID: 29603363 PMCID: PMC6001537 DOI: 10.1002/ajh.25097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
Sickle cell disease (SCD) in pregnancy can be associated with adverse maternal and perinatal outcomes. Furthermore, complications of SCD can be aggravated by pregnancy. Optimal prenatal care aims to decrease the occurrence of maternal and fetal complications. A retrospective, French, two-center study compared two care strategies for pregnant women with SCD over two time periods. In the first study period (2005-2010), the women were systematically offered prophylactic transfusions. In the second study period (2011-2014), a targeted transfusion strategy was applied whenever possible, and home-based prophylactic nocturnal oxygen therapy was offered to all the pregnant women. The two periods did not differ significantly in terms of the incidence of vaso-occlusive events. Maternal mortality, perinatal mortality, and obstetric complication rates were also similar in the two periods, as was the incidence of post-transfusion complications (6.1% in 2005-2010 and 1.3% in 2011-2014, P = .15), although no de novo alloimmunizations or delayed hemolysis transfusion reactions were observed in the second period. The results of this preliminary, retrospective study indicate that targeted transfusion plus home-based prophylactic nocturnal oxygen therapy is safe and may decrease transfusion requirements and transfusion-associated complications.
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Affiliation(s)
- Jean‐Antoine Ribeil
- Biotherapy DepartmentNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
- Biotherapy CIC, West University Hospital Group, Assistance Publique‐Hôpitaux de Paris, INSERMParisFrance
| | - Myriam Labopin
- Clinical Hematology and Cellular Therapy DepartmentSaint‐Antoine Hospital, Assistance Publique‐Hôpitaux de Paris, France ‐ INSERM UMRs 938, Pierre et Marie Curie University (UPMC, Paris VI)ParisFrance
| | - Aurélie Stanislas
- Biotherapy DepartmentNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
- Biotherapy CIC, West University Hospital Group, Assistance Publique‐Hôpitaux de Paris, INSERMParisFrance
| | - Benjamin Deloison
- Department of Obstetrics and Fetal MedicineNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Delphine Lemercier
- Department of Obstetrics and Fetal MedicineNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Anoosha Habibi
- Reference Center for Sickle Cell Disease, Henri Mondor Hospital, Assistance Publique‐Hôpitaux de ParisCréteilFrance
| | - Souha Albinni
- Necker Children's HospitalFrench Blood Establishment ‐ Ile de FranceParisFrance
| | - Caroline Charlier
- Necker Children's Hospital, Assistance Publique‐Hôpitaux de ParisNecker Pasteur Center for Infectious Diseases and Tropical MedicineParisFrance
| | - Olivier Lortholary
- Imagine InstituteParisFrance
- Necker Children's Hospital, Assistance Publique‐Hôpitaux de ParisNecker Pasteur Center for Infectious Diseases and Tropical MedicineParisFrance
- Paris Descartes UniversityParisFrance
| | - François Lefrere
- Biotherapy DepartmentNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
- Biotherapy CIC, West University Hospital Group, Assistance Publique‐Hôpitaux de Paris, INSERMParisFrance
| | - Mariane De Montalembert
- Reference Centre for Sickle Cell Disease, Pediatric DepartmentNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Stéphane Blanche
- Unit of Pediatric Immunology and HematologyNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Frédéric Galactéros
- Reference Center for Sickle Cell Disease, Henri Mondor Hospital, Assistance Publique‐Hôpitaux de ParisCréteilFrance
| | - Jean‐Marc Tréluyer
- Paris Descartes UniversityParisFrance
- Necker Children's Hospital, Assistance Publique‐Hôpitaux de ParisClinical Research Unit/Clinical Investigation CentreParisFrance
| | - Eliane Gluckman
- Saint‐Louis Hospital, Paris, France and Monaco Scientific CenterEurocord Monacord International Observatory on Sickle Cell DiseaseMonaco
| | - Yves Ville
- Department of Obstetrics and Fetal MedicineNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Laure Joseph
- Biotherapy DepartmentNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Marianne Delville
- Biotherapy DepartmentNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology and Reproductive MedicineAntoine Béclère Hospital, Assistance Publique‐Hôpitaux de Paris, Université Paris SudClamartFrance
| | - Marina Cavazzana
- Biotherapy DepartmentNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
- Biotherapy CIC, West University Hospital Group, Assistance Publique‐Hôpitaux de Paris, INSERMParisFrance
- Paris Descartes UniversityParisFrance
- Unit of Pediatric Immunology and HematologyNecker Children's Hospital, Assistance Publique‐Hôpitaux de ParisParisFrance
- Saint‐Louis Hospital, Paris, France and Monaco Scientific CenterEurocord Monacord International Observatory on Sickle Cell DiseaseMonaco
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18
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Prophet J, Kelly K, Domingo J, Ayeni H, Mekouguem XPD, Dockery B, Allam F, Kaur M, Artis J, Spooner KK, Salemi JL, Olaleye OA, Salihu HM. Severe pre-eclampsia among pregnant women with sickle cell disease and HIV. Pregnancy Hypertens 2018. [PMID: 29523281 DOI: 10.1016/j.preghy.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The relationship between sickle cell disease (SCD) and severe pre-eclampsia is poorly established. It is also unknown whether the occurrence of HIV infection among women with SCD modifies their risk level for severe pre-eclampsia. We hypothesized that pregnant women with SCD are at an elevated risk for severe pre-eclampsia as a result of heightened endothelial damage; and the combination of SCD-HIV augments the inflammatory processes of endothelial damage leading to amplified risk for severe pre-eclampsia. STUDY DESIGN We analyzed more than 57 million pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014. MAIN OUTCOME MEASURES We applied multivariable survey logistic regression to generate odds ratios for the association between SCD, HIV and SCD-HIV status and severe pre-eclampsia with adjustment for potential confounders. RESULTS Of the total 57,326,459 pregnant women, 57,198,505 (99.78%) did not have SCD or HIV, 73,064 (12.7 per 10,000) had HIV only, 54,890 (9.58 per 10,000) had SCD only and 222 (0.39 per 100,000) had both SCD and HIV. Mothers with SCD and HIV-SCD experienced a significant elevation in risk for severe pre-eclampsia of about 60% (OR = 1.61; 95% CI = 1.44, 1.79) and of more than 300% (OR = 4.28; 95% CI = 1.35, 13.62) respectively. CONCLUSION In the largest study on SCD and pre-eclampsia in the world, we established SCD to be strongly associated with severe pre-eclampsia. Another unique finding is the synergistic effect of amplified risk for severe pre-eclampsia among mothers with the combined SCD-HIV status.
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Affiliation(s)
- Javon Prophet
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA
| | - Kalifa Kelly
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA
| | - Julian Domingo
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA
| | - Helen Ayeni
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA
| | | | - Breana Dockery
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA
| | - Farida Allam
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA
| | - Manvir Kaur
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA.
| | - Javon Artis
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA
| | - Kiara K Spooner
- Baylor College of Medicine, Department of Family & Community Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA.
| | - Jason L Salemi
- Baylor College of Medicine, Department of Family & Community Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA.
| | - Omonike A Olaleye
- Texas Southern University, 3100 Cleburne Street, Houston, TX 77004, USA.
| | - Hamisu M Salihu
- Baylor College of Medicine, Department of Family & Community Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA.
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Lari NF, DeBaun MR, Oppong SA. The emerging challenge of optimal blood pressure management and hypertensive syndromes in pregnant women with sickle cell disease: a review. Expert Rev Hematol 2017; 10:987-994. [DOI: 10.1080/17474086.2017.1379895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nabilah F. Lari
- Department of Family Medicine, Meharry Medical College, Nashville, TN, USA
| | - Michael R. DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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20
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Okusanya BO, Oladapo OT. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy. Cochrane Database Syst Rev 2016; 12:CD010378. [PMID: 28005272 PMCID: PMC6463955 DOI: 10.1002/14651858.cd010378.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies. This is an update of a Cochrane review that was published in 2013. OBJECTIVES To assess the benefits and harms of a policy of prophylactic versus selective blood transfusion in pregnant women with sickle cell disease. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2016) and reference lists of retrieved studies. We did not apply any language or date restrictions. SELECTION CRITERIA Randomised controlled trials evaluating the effects of prophylactic versus selective (emergency) blood transfusion in pregnant women with sickle cell disease (SCD). Quasi-randomised trials and trials using a cluster-randomised design were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two review authors independently assessed the quality of the evidence using the GRADE approach. MAIN RESULTS Out of six relevant reports identified by the search strategy, one trial involving 72 women with sickle cell anaemia (HbSS) met our inclusion criteria. The trial was at unclear risk of bias. Overall, there were few events for most of the reported outcomes and the results were generally imprecise. The included trial reported no maternal mortality occurring in women who received either prophylactic or selective blood transfusion. Very low-quality evidence indicated no clear differences in maternal mortality, perinatal mortality (risk ratio (RR) 2.85, 95% confidence interval (CI) 0.61 to 13.22; very low-quality evidence) or markers of severe maternal morbidity (pulmonary embolism (no events); congestive cardiac failure (RR 1.00, 95% CI 0.07 to 15.38; very low-quality evidence); acute chest syndrome (RR 0.67, 95% CI 0.12 to 3.75)) between the treatment groups (prophylactic blood transfusion versus selective blood transfusion). Low-quality evidence indicated that prophylactic blood transfusion reduced the risk of pain crisis compared with selective blood transfusion (RR 0.28, 95% CI 0.12 to 0.67, one trial, 72 women; low-quality evidence), and no differences in the occurrence of acute splenic sequestration (RR 0.33, 95% CI 0.01 to 7.92; low-quality evidence), haemolytic crises (RR 0.33, 95% CI 0.04 to 3.06) or delayed blood transfusion reaction (RR 2.00, 95% CI 0.54 to 7.39; very low-quality evidence) between the comparison groups.Other relevant maternal outcomes pre-specified for this review such as cumulative duration of hospital stay, postpartum haemorrhage and iron overload, and infant outcomes, admission to neonatal intensive care unit (NICU) and haemolytic disease of the newborn, were not reported by the trial. AUTHORS' CONCLUSIONS Evidence from one small trial of very low quality suggests that prophylactic blood transfusion to pregnant women with sickle cell anaemia (HbSS) confers no clear clinical benefits when compared with selective transfusion. Currently, there is no evidence from randomised or quasi-randomised trials to provide reliable advice on the optimal blood transfusion policy for women with other variants of sickle cell disease (i.e. HbSC and HbSβThal). The available data and quality of evidence on this subject are insufficient to advocate for a change in existing clinical practice and policy.
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Affiliation(s)
- Babasola O Okusanya
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi‐ArabaExperimental and Maternal Medicine Unit, Department of Obstetrics and GynaecologyLagosNigeria
| | - Olufemi T Oladapo
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
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Kuo K, Caughey AB. Contemporary outcomes of sickle cell disease in pregnancy. Am J Obstet Gynecol 2016; 215:505.e1-5. [PMID: 27242200 DOI: 10.1016/j.ajog.2016.05.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/10/2016] [Accepted: 05/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data regarding pregnancy outcomes in sickle cell disease are conflicting. Previous studies are limited by small sample size, narrow geographic area, and a wide range of resource availability. OBJECTIVE The purpose of this study was to examine the association between maternal sickle cell disease and adverse pregnancy outcomes in a contemporary North American cohort. STUDY DESIGN We performed a retrospective cohort study of 2,027,323 women with singleton pregnancies delivered in California from 2005-2008. Deliveries at <24 or >42 6/7 weeks of gestation were excluded. Women with sickle cell disease were compared with control subjects. Maternal outcomes of interest included preeclampsia, preterm delivery, placental abruption, oligohydramnios, and cesarean delivery; neonatal outcomes included small for gestational age, anomalies, stillbirth, neonatal death, and infant death. RESULTS The prevalence of sickle cell disease was 0.017%. Compared with control subjects, women with sickle cell disease were more likely to have limited prenatal care (7.4 vs 3.8%; P=.001), underlying chronic hypertension (2.3% vs 1.1%; P=.038), and fetal anomalies (14.0 vs 6.4%; P<.001). The increased odds of fetal anomalies persisted after adjustment for multiple confounders (odds ratio, 1.73; 95% confidence interval, 1.26-2.38). Women with sickle cell disease also had higher odds of severe preeclampsia (odds ratio, 3.75; 95% confidence interval, 2.21-6.38), preterm delivery (odds ratio, 2.50; 95% confidence interval, 1.93-3.21), small for gestational age (odds ratio, 1.96; 95% confidence interval, 1.18-3.25), and cesarean delivery (odds ratio, 1.93; 95% confidence interval, 1.40-2.67). CONCLUSION Women with sickle cell disease are at high risk of maternal and neonatal morbidity. Low rates of fetal and neonatal death may reflect improved antenatal surveillance and management as compared with previous studies. The association between sickle cell disease and fetal anomalies warrants further investigation.
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Affiliation(s)
- Kelly Kuo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Afolabi BB, Oladipo OO, Akanmu AS, Abudu OO, Sofola OA, Broughton Pipkin F. Volume regulatory hormones and plasma volume in pregnant women with sickle cell disorder. J Renin Angiotensin Aldosterone Syst 2016; 17:17/3/1470320316670444. [PMID: 27678389 PMCID: PMC5843859 DOI: 10.1177/1470320316670444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/18/2016] [Indexed: 12/15/2022] Open
Abstract
Background: Sickle cell disease (haemoglobin SS (HbSS)) mainly affects those of West African origin and is associated with hypervolaemia. Plasma volume rises by up to 50% in normal pregnancy but was previously found to be paradoxically contracted in late sickle cell pregnancy. The renin–angiotensin–aldosterone system is activated very early in human pregnancy to support the plasma volume expansion. We hypothesised that activation of the renin–angiotensin–aldosterone system would be blunted in pregnant women with sickle cell disease. Materials and methods: We measured plasma volume and concentrations of plasma renin, angiotensinogen, aldosterone and other volume-related hormones in a cross-sectional study of pregnant and non-pregnant Nigerian women with HbSS or HbAA. Results: Plasma volume was higher in non-pregnant HbSS than HbAA women, but had not risen by 16 weeks, unlike plasma volume in HbAA women. The concentration of plasma renin also rose significantly less by 16 weeks in HbSS; angiotensinogen and aldosterone concentrations increased. Conclusions: The lower plasma renin concentration at 16 weeks with HbSS could be either primary or secondary to vasoconstriction related to inadequate vasodilator activity. The contracted plasma volume might then stimulate aldosterone synthesis by non-angiotensin II dependent stimulation. Studies of vasodilators such as nitric oxide, vasodilator eicosanoids or the PlGF/VEGF/sFlT-1 axis in pregnant HbSS and HbAA women will test this hypothesis.
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Affiliation(s)
- Bosede B Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Nigeria
| | | | - Alani S Akanmu
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Nigeria
| | - Olalekan O Abudu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Nigeria
| | - Olusoga A Sofola
- Department of Physiology, College of Medicine, University of Lagos, Nigeria
| | - Fiona Broughton Pipkin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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Elenga N, Adeline A, Balcaen J, Vaz T, Calvez M, Terraz A, Accrombessi L, Carles G. Pregnancy in Sickle Cell Disease Is a Very High-Risk Situation: An Observational Study. Obstet Gynecol Int 2016; 2016:9069054. [PMID: 27403164 PMCID: PMC4926018 DOI: 10.1155/2016/9069054] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/06/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022] Open
Abstract
Sickle cell disease is a serious genetic disorder affecting 1/235 births in French Guiana. This study aimed to describe the follow-up of pregnancies among sickle cell disease patients in Cayenne Hospital, in order to highlight the most reported complications. 62 records of pregnancies were analyzed among 44 females with sickle cell disease, between 2007 and 2013. Our results were compared to those of studies conducted in Brazil and Guadeloupe. There were 61 monofetal pregnancies and 2 twin pregnancies, 27 pregnancies among women with SS phenotype, 30 SC pregnancies, and five S-beta pregnancies. The study showed that the follow-up of patients was variable, but no maternal death was found. We also noted that the main maternofetal complications of pregnancies were anemia (36.5%), infection (31.7%), vasoocclusive crisis (20.6%), preeclampsia (17.5%), premature birth (11.1%), intrauterine growth retardation (15.9%), abnormal fetal heart rate (14.3%), and intrauterine fetal death (4.8%). Pregnancies were more at risk among women with SS phenotype. Pregnancy in sickle cell disease patients requires a supported multidisciplinary team including the primary care physician, the obstetrician, and the Integrated Center for Sickle Cell Disease.
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Affiliation(s)
- Narcisse Elenga
- Pediatric Unit, Centre Hospitalier de Cayenne “Andrée Rosemon”, rue des Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
- Integrated Center of Sickle Cell Disease (ICS), Centre Hospitalier de Cayenne “Andrée Rosemon”, rue des Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
| | - Aurélie Adeline
- Integrated Center of Sickle Cell Disease (ICS), Centre Hospitalier de Cayenne “Andrée Rosemon”, rue des Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
| | - John Balcaen
- Integrated Center of Sickle Cell Disease (ICS), Centre Hospitalier de Cayenne “Andrée Rosemon”, rue des Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
| | - Tania Vaz
- Integrated Center of Sickle Cell Disease (ICS), Centre Hospitalier de Cayenne “Andrée Rosemon”, rue des Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
| | - Mélanie Calvez
- Integrated Center of Sickle Cell Disease (ICS), Centre Hospitalier de Cayenne “Andrée Rosemon”, rue des Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
| | - Anne Terraz
- Department of Medical Information, Centre Hospitalier de Cayenne “Andrée Rosemon”, rue des Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
| | - Laetitia Accrombessi
- Obstetrics and Gynecology Unit, Centre Hospitalier de Cayenne “Andrée Rosemon”, rue des Flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana
| | - Gabriel Carles
- Obstetrics and Gynecology Unit, Centre Hospitalier de l'Ouest Guyanais Franck Joly, 16 boulevard du Général de Gaulle, BP 245, 97393 Saint-Laurent-du-Maroni, French Guiana
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Boafor TK, Olayemi E, Galadanci N, Hayfron-Benjamin C, Dei-Adomakoh Y, Segbefia C, Kassim AA, Aliyu MH, Galadanci H, Tuuli MG, Rodeghier M, DeBaun MR, Oppong SA. Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis. BJOG 2015; 123:691-8. [DOI: 10.1111/1471-0528.13786] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/26/2022]
Affiliation(s)
- TK Boafor
- Department of Obstetrics and Gynaecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - E Olayemi
- Department of Haematology; University of Ghana Medical School; Accra Ghana
| | - N Galadanci
- Vanderbilt Center of Excellence in Sickle Cell Disease; Vanderbilt Children's Hospital and Vanderbilt University School of Medicine; Nashville TN USA
| | - C Hayfron-Benjamin
- Department of Physiology; University of Ghana Medical School; Accra Ghana
| | - Y Dei-Adomakoh
- Department of Haematology; University of Ghana Medical School; Accra Ghana
| | - C Segbefia
- Department of Child Health; University of Ghana Medical School; Accra Ghana
| | - AA Kassim
- Vanderbilt Center of Excellence in Sickle Cell Disease; Vanderbilt Children's Hospital and Vanderbilt University School of Medicine; Nashville TN USA
| | - MH Aliyu
- Vanderbilt Center of Excellence in Sickle Cell Disease; Vanderbilt Children's Hospital and Vanderbilt University School of Medicine; Nashville TN USA
| | | | - MG Tuuli
- Department of Obstetrics and Gynecology; Washington University in St Louis; St Louis MO USA
| | | | - Michael R DeBaun
- Vanderbilt Center of Excellence in Sickle Cell Disease; Vanderbilt Children's Hospital and Vanderbilt University School of Medicine; Nashville TN USA
| | - SA Oppong
- Department of Obstetrics and Gynaecology; University of Ghana Medical School; Accra Ghana
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Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis. Blood 2015; 126:2424-35; quiz 2437. [DOI: 10.1182/blood-2015-06-649319] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/19/2015] [Indexed: 11/20/2022] Open
Abstract
Key Points
Prophylactic transfusion in pregnant women with SCD may reduce maternal mortality, vaso-occlusive pain events, and pulmonary complications. Prophylactic transfusion in pregnant women with SCD may similarly reduce perinatal mortality, neonatal death, and preterm birth.
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26
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Lesage N, Deneux Tharaux C, Saucedo M, Habibi A, Galacteros F, Girot R, Bouvier Colle M, Kayem G. Maternal mortality among women with sickle-cell disease in France, 1996–2009. Eur J Obstet Gynecol Reprod Biol 2015; 194:183-8. [DOI: 10.1016/j.ejogrb.2015.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 11/26/2022]
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Adewoyin AS. Management of sickle cell disease: a review for physician education in Nigeria (sub-saharan Africa). Anemia 2015; 2015:791498. [PMID: 25667774 PMCID: PMC4312619 DOI: 10.1155/2015/791498] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/18/2014] [Accepted: 12/17/2014] [Indexed: 11/27/2022] Open
Abstract
Sickle cell disease (SCD) predominates in sub-Saharan Africa, East Mediterranean areas, Middle East, and India. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades have witnessed remarkable scientific progress in the understanding of the complex pathophysiology of the disease. Improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic blood transfusions, hydroxyurea therapy, and haemopoietic stem cell transplantation. Coupled with parallel improvements in general supportive, symptomatic, and preventive measures, current evidence reveals remarkable appreciation in quality of life among affected individuals in developed nations. Currently, in Nigeria and other West African states, treatment and control of SCD are largely suboptimal. Improved knowledge regarding SCD phenotypes and its comprehensive care among Nigerian physicians will enhance quality of care for affected persons. This paper therefore provides a review on the aetiopathogenesis, clinical manifestations, and management of SCD in Nigeria, with a focus on its local patterns and peculiarities. Established treatment guidelines as appropriate in the Nigerian setting are proffered, as well as recommendations for improving care of affected persons.
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Affiliation(s)
- Ademola Samson Adewoyin
- Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria
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28
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Oteng-Ntim E, Ayensah B, Knight M, Howard J. Pregnancy outcome in patients with sickle cell disease in the UK - a national cohort study comparing sickle cell anaemia (HbSS) with HbSC disease. Br J Haematol 2014; 169:129-37. [DOI: 10.1111/bjh.13270] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 11/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Eugene Oteng-Ntim
- King's College London; London UK
- Directorate of Women's Health; Guy's and St Thomas' Foundation Trust; London UK
| | - Benjamin Ayensah
- Directorate of Women's Health; Guy's and St Thomas' Foundation Trust; London UK
| | - Marian Knight
- Perinatal Epidemiology Unit; University of Oxford; Oxford UK
| | - Jo Howard
- Department of Haematology; Guy's and St Thomas' NHS Foundation Trust; London UK
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Costa VMF, Viana MB, Aguiar RALP. Pregnancy in patients with sickle cell disease: maternal and perinatal outcomes. J Matern Fetal Neonatal Med 2014; 28:685-9. [PMID: 24866352 DOI: 10.3109/14767058.2014.928855] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare obstetrical, hematological and neonatal outcomes of pregnant women with or without sickle cell disease (SCD). METHODS A prospective study of 60 pregnancies of 58 women with SCD (29 SCD-SS and 29 SCD-SC) compared with 192 pregnancies in 187 healthy pregnant women was carried out from January 2009 to August 2011. RESULTS Compared to controls, the SCD group had higher rate of preterm delivery (p < 0.001, OR = 4.96, 95% CI 2.57-9.59), higher cesarean rate (p < 0.001, OR = 5.00, CI 2.65-9.45), more frequent deep vein thrombosis (p = 0.003), and urinary infection (p = 0.001, OR = 3.31, CI 1.63-6.73), higher prevalence of small for gestational age babies (p = 0.019, OR = 2.66, CI 1.15-6.17), and more frequent baby admissions to progressive care unit (p < 0.001, OR = 4.89, CI 2.26-10.6). Maternal death rate was also higher among women with SCD (p = 0.056). All adverse events were more frequent in the SS subgroup. Babies from the SS subgroup had the lowest weight at birth (2080 g) compared to SC (2737 g; p < 0.001) and controls (3035 g). A multivariate analysis confirmed painful episodes and SS genotype as factors contributing to preterm delivery. CONCLUSION SCD pregnant women - especially those in the SS subgroup - are more prone to experience perinatal and maternal complications in comparison with pregnant women without SCD.
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Resende Cardoso PS, Lopes Pessoa de Aguiar RA, Viana MB. Clinical complications in pregnant women with sickle cell disease: prospective study of factors predicting maternal death or near miss. Rev Bras Hematol Hemoter 2014; 36:256-63. [PMID: 25031164 PMCID: PMC4207919 DOI: 10.1016/j.bjhh.2014.05.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/06/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate complications in pregnant women with sickle cell disease, especially those leading to maternal death or near miss (severe obstetric complications). METHODS A prospective cohort of 104 pregnant women registered in the Blood Center of Belo Horizonte (Hemominas Foundation) was followed up at high-risk prenatal units. They belonged to Group I (51 hemoglobin SS and three hemoglobin S/β(0)-thalassemia) or Group II (49 hemoglobin SC and one hemoglobin S/β(+)-thalassemia). Both groups had similar median ages. Predictive factors for 'near miss' or maternal death with p-value≤0.25 in the univariate analysis were included in a multivariate logistic model (significance set for p-value≤0.05). RESULTS Group I had more frequent episodes of vaso-occlusive crises, more transfusions in the antepartum and postpartum, and higher percentage of preterm deliveries than Group II. Infections and painful crises during the postpartum period were similar in both the groups. The mortality rate was 4.8%: three deaths in Group I and two in Group II. One-third of the women in both the groups experienced near miss. The most frequent event was pneumonia/acute chest syndrome. Alpha-thalassemia co-inheritance and β-gene haplotypes were not associated with near miss or maternal death. In multivariate analysis predictors of near miss or death were parity above one and baseline red blood cell macrocytosis. In Group I, baseline hypoxemia (saturation<94%) was also predictive of near miss or death. CONCLUSION One-third of pregnant women had near miss and 4.8% died. Both hemoglobin SS and SC pregnant women shared the same risk of death or of severe complications, especially pulmonary events.
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Okusanya BO, Oladapo OT. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy. Cochrane Database Syst Rev 2013:CD010378. [PMID: 24297507 DOI: 10.1002/14651858.cd010378.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies. The present review replaces and updates a Cochrane review that was withdrawn in 2006. OBJECTIVES To assess the benefits and harms of a policy of prophylactic versus selective blood transfusion in pregnant women with sickle cell disease. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2013) and reference lists of retrieved studies. We did not apply any language restrictions. SELECTION CRITERIA Randomised and quasi-randomised trials evaluating the effects of prophylactic versus selective (emergency) blood transfusion in pregnant women with sickle cell disease. Trials were considered for inclusion whether the unit of randomisation was at individual or cluster level, however, no cluster-randomised trials were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy. MAIN RESULTS Out of six relevant reports identified by the search strategy, two trials involving 98 women with sickle cell anaemia (HbSS) met our inclusion criteria. The two trials were at moderate risk of bias. Overall, there were few events for most of the reported outcomes and the results were generally imprecise. One trial (involving 72 women) reported no maternal mortality occurring in women who received either prophylactic or selective blood transfusion. The same trial (involving 72 women) indicated no clear differences in maternal mortality, perinatal mortality (risk ratio (RR) 2.85, 95% confidence interval (CI) 0.61 to 13.22) or markers of severe maternal morbidity [pulmonary embolism (no events); congestive cardiac failure (RR 1.00, 95% CI 0.07 to 15.38); acute chest syndrome (RR 0.67, 95% CI 0.12 to 3.75)] between the treatment groups (prophylactic blood transfusion versus selective blood transfusion). Prophylactic blood transfusion reduced the risk of pain crisis compared with selective blood transfusion (RR 0.42, 95% CI 0.17 to 0.99, two trials, 98 women); however, the margin of uncertainty around the effect estimate ranged from very small to substantial reduction. One trial (involving 72 women) indicated no differences in the occurrence of acute splenic sequestration (RR 0.33, 95% CI 0.01 to 7.92) and haemolytic crises (RR 0.33, 95% CI 0.04 to 3.06) and delayed blood transfusion reaction (RR 2.00, 95% CI 0.54 to 7.39) between the comparison groups. AUTHORS' CONCLUSIONS Evidence from two small trials of low quality suggests that prophylactic blood transfusion to pregnant women with sickle cell anaemia (HbSS) confers no clear clinical benefits when compared with selective transfusion. Currently, there is no evidence from randomised or quasi-randomised trials to provide reliable advice on the optimal blood transfusion policy for women with other variants of sickle cell disease (i.e. HbSC and HbSβThal). The available data and quality of evidence on this subject are insufficient to advocate for a change in existing clinical practice and policy.
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Affiliation(s)
- Babasola O Okusanya
- Experimental and Maternal Medicine Unit, Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Okusanya BO, Oladapo OT. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sickle cell disease in pregnancy: trend and pregnancy outcomes at a tertiary hospital in Tanzania. PLoS One 2013; 8:e56541. [PMID: 23418582 PMCID: PMC3572068 DOI: 10.1371/journal.pone.0056541] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022] Open
Abstract
SCD in pregnancy is associated with increased adverse fetal and maternal outcomes. In Tanzania where the frequency of sickle cell trait is 13% there has been scanty data on SCD in pregnancy. With progressive improvement in childhood survival the burden of SCD in pregnancy will increase. We analyzed all deliveries at Muhimbili National Hospital (MNH) from 1999 to 2011. Fetal and maternal outcomes of SCD deliveries were compared with non-SCD. Data were analyzed using IBM SPSS statistics version 19. Chi square and Fisher Exact tests were used to compare proportions and the independent t-test for continuous data. To predict risks of adverse effects, odds ratios were determined using multivariate logistic regression. A p-value<0.05 was considered significant. In total, 157,473 deliveries occurred at MNH during the study period, of which 149 were SCD (incidence of 95 SCD per 100,000 deliveries). The incidence of SCD had increased from 76 per 100,000 deliveries in the 1999–2002 period to over 100 per 100, 000 deliveries in recent years. The mean maternal age at delivery was lower in SCD (24.0±5.5 years) than in non-SCD deliveries (26.2±6.0 years), p<0.001. Compared with non-SCD (2.9±0.7 Kg), SCD deliveries had less mean birth-weight (2.6±0.6 Kg), p<0.001. SCD were more likely than non-SCD to deliver low APGAR score at 5 minutes (34.5% Vs 15.0%, OR = 3.0, 95%CI: 2.1–4.2), stillbirths (25.7% Vs 7.5%, OR = 4.0, 95%CI: 2.8–5.8). There was excessive risk of maternal deaths in SCD compared to non-SCD (11.4% Vs 0.4%, OR = 29, 95%CI: 17.3–48.1). The leading cause of deaths in SCD was infections in wholly 82% in contrast to only 32% in non-SCD. In conclusion SCD in pregnancy is an emerging problem at MNH with increased adverse fetal outcomes and excessive maternal mortality mainly due to infections.
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Wilson NO, Ceesay FK, Hibbert JM, Driss A, Obed SA, Adjei AA, Gyasi RK, Anderson WA, Stiles JK. Pregnancy outcomes among patients with sickle cell disease at Korle-Bu Teaching Hospital, Accra, Ghana: retrospective cohort study. Am J Trop Med Hyg 2012; 86:936-42. [PMID: 22665597 DOI: 10.4269/ajtmh.2012.11-0625] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pregnancy in sickle cell disease (SCD) patients is associated with increased risk of maternal and fetal mortality. This study determines pregnancy outcomes among women with SCD delivering at Korle-Bu Teaching Hospital, Accra, Ghana. Nine hundred sixty (960) medical records of pregnant women (131 HbSS, 112 HbSC, and 717 comparison group) from 2007 to 2008 were reviewed. The HbSS women were at increased risk of eclampsia (adjusted odds ratio [AOR] = 10.56, 95% confidence interval [CI] = 3.60-30.96, P < 0.001), intrauterine growth restriction (AOR = 4.00, 95% CI = 1.38-11.64, P = 0.011), and placenta previa (AOR = 22.03, 95% CI = 9.87-49.14, P < 0.001) compared with the comparison group. The HbSC women had increased risk for intrauterine fetal death (AOR = 3.38, 95% CI = 1.15-9.96, P = 0.027) and decreased risk of delivering low birth weight babies (AOR = 0.21, 95% CI = 0.06-0.73, P = 0.014). Women with SCD in Ghana are at a greater risk of morbidity and mortality in pregnancy compared with women without hemoglobinopathies. Improved maternal and fetal outcomes in Ghanaian women with SCD can be achieved through effective intervention by health care providers with thorough knowledge about predisposing factors toward adverse outcomes.
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Affiliation(s)
- Nana O Wilson
- Morehouse School of Medicine, Department of Microbiology, Biochemistry and Immunology, Atlanta, GA 30310, USA.
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Howard J, Oteng-Ntim E. The obstetric management of sickle cell disease. Best Pract Res Clin Obstet Gynaecol 2012; 26:25-36. [DOI: 10.1016/j.bpobgyn.2011.10.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 10/19/2011] [Indexed: 10/15/2022]
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Excess risk of maternal death from sickle cell disease in Jamaica: 1998-2007. PLoS One 2011; 6:e26281. [PMID: 22039456 PMCID: PMC3200316 DOI: 10.1371/journal.pone.0026281] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/23/2011] [Indexed: 11/19/2022] Open
Abstract
Background Decreases 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. Methods Demographic, 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. Results Women 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. Conclusions Women 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.
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