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Yasin F, McGann P, Van Doren L. Hydroxyurea in pregnancy: Reframing the conversation. Am J Hematol 2024; 99:1214-1216. [PMID: 38546327 DOI: 10.1002/ajh.27299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Faiza Yasin
- Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Patrick McGann
- Lifespan Comprehensive Sickle Cell Center, Providence, Rhode Island, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Layla Van Doren
- Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Hachey SM, Joseph S, Dolin CD, Triebwasser JE, Sayani F, Hamm RF. Contemporary Obstetric and Neonatal Outcomes in Sickle Cell Disease: A Retrospective Cohort Study. Am J Perinatol 2024; 41:e2291-e2298. [PMID: 37494482 DOI: 10.1055/s-0043-1771050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Sickle cell disease is associated with adverse perinatal outcomes. Aspects of sickle cell disease in pregnancy, such as health care utilization and neonatal abstinence syndrome, are understudied. We aimed to describe contemporary sickle cell disease outcomes in a U.S. hospital system to improve perinatal counseling. STUDY DESIGN We conducted a retrospective cohort study of patients with sickle cell disease who delivered at >20 weeks' gestation at two sites within the University of Pennsylvania Health System from May 1, 2017 to August 30, 2020. Descriptive statistics were utilized. RESULTS Over the study period, 48 patients with sickle cell disease had 52 deliveries of 53 neonates. Sickle cell disease-related morbidity was prevalent prior to pregnancy; 27% had a history of avascular necrosis, and 58% had experienced acute chest syndrome. In the year prior to pregnancy, 52% used daily opioids. During pregnancy, more than half of patients were admitted at least once for sickle cell disease-related complications, spending a median 3 days admitted interquartile range (0-23); >10% spent >70 days of pregnancy admitted. New daily opioids were prescribed during pregnancy for 10% to manage pain crises. Acute chest syndrome was experienced by 23% of patients during pregnancy, and 8% required placement of long-term intravenous access. Preterm delivery <37 weeks occurred in 48%. The primary cesarean rate in nulliparas was 43%. Additionally, 50% experienced a hypertensive disorder of pregnancy, 35% underwent transfusion during delivery admission, and 10% had a perinatal venous thromboembolism. Finally, 53% of neonates were admitted to the intensive care unit. Low birth weight was noted in 34%, severe respiratory distress in 15% of infants, and neonatal abstinence syndrome in 21%. CONCLUSION Sickle cell disease remains associated with significant perinatal morbidity and need for hospitalization. These data provide contemporary outcomes to target improvements in the care of patients with sickle cell disease. KEY POINTS · SCD was associated with significant perinatal morbidity and healthcare utilization.. · Most patients with SCD required hospitalization during pregnancy.. · Neonates of patients with SCD experienced preterm birth, NICU admission, and neonatal abstinence syndrome..
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Affiliation(s)
- Sara M Hachey
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sophie Joseph
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cara D Dolin
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
| | - Jourdan E Triebwasser
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Farzana Sayani
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rebecca F Hamm
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
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Figueira CO, Guida JPS, Surita FG, Antolini-Tavares A, Saad ST, Costa FF, Fertrin KY, Costa ML. Sickle cell disease and increased adverse maternal and perinatal outcomes in different genotypes. Hematol Transfus Cell Ther 2024:S2531-1379(24)00056-7. [PMID: 38494406 DOI: 10.1016/j.htct.2024.02.013] [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: 06/21/2023] [Revised: 11/23/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) comprises a heterogeneous group of inherited hemolytic disorders that increases the risk of maternal and perinatal complications due to chronic systemic inflammatory response, endothelial damage and vaso-occlusion. The contribution of genotypes to the severity of outcomes during pregnancy is not completely established. METHODS A retrospective study of medical charts was performed to compare maternal and perinatal outcomes in Hb SS, Hb SC disease and sickle-beta thalassemia (Hb Sβ) pregnancies followed at a high-risk antenatal care unit over a 6-year period. A descriptive analysis of morphological findings was performed of the placenta when pathology reports were available. RESULTS Sixty-two SCD pregnant women [25 Hb SS (40 %), 29 Hb SC (47 %) and 8 Hb Sβ (13 %)] were included. Overall, SCD was associated with maternal complications (77 %), preterm birth (30 %), cesarean section (80 %) and a need of blood transfusion. In general there were no statistically significant differences between genotypes. The only significant difference was the hemoglobin level at first antenatal care visit which was lower for the homozygous genotype (7.7 g/dL) compared to Hb SC and Hb Sβ (9.7 g/dL and 8.4 g/dL, respectively; p-value = 0.01). Ten of 15 evaluated placentas showed abnormal morphological findings CONCLUSION: SCD, regardless of the underlying genotype, is associated with increased adverse maternal and perinatal outcomes and placental abnormalities associated with maternal vascular malperfusion.
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Affiliation(s)
- Camilla Olivares Figueira
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - José Paulo S Guida
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - Arthur Antolini-Tavares
- Department of Pathological Anatomy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Sara T Saad
- Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Fernando F Costa
- Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Kleber Y Fertrin
- Division of Hematology, Department of Medicine, University of Washington, WA 98195, Seattle, WA, USA
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil.
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Early ML, Luo A, Solow M, Matusiak K, Eke AC, Shehata N, August P, Kuo KH, Lanzkron S, Malinowski AK, Pecker LH. Natural history of blood pressure in sickle cell disease pregnancy. Br J Haematol 2024; 204:658-667. [PMID: 37803527 PMCID: PMC10903988 DOI: 10.1111/bjh.19133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
In this retrospective cohort study of singleton pregnancies in people with sickle cell disease (SCD) delivered at two academic centres between 1990 and 2021, we collected demographic and SCD-related data, pregnancy outcomes, and the highest systolic and diastolic blood pressure (SBP and DBP) at seven time periods. We compared blood pressure values and trajectories in the composite cohort and in each genotype group to control values in a non-SCD pregnancy dataset. There were 290 pregnancies among 197 patients with SCD. Sixteen per cent (n = 47) of pregnancies had a hypertensive disorder of pregnancy (HDP); the rates did not differ by genotype. The mean SBP and DBP were lower in the HbSS/HbSβ0 group than in the non-SCD control group at all timepoints. Mean SBP and DBP trajectories were similar between the HbSS/HbSβ0 group and non-SCD controls, whereas the mean SBP and DBP in the HbSC/HbSβ+ group decreased between the first and second trimesters and plateaued between the second and third trimesters. There were no differences in blood pressure trajectory by haemoglobin >/< 10 gm/dL or by chronic transfusion status. Overall, pregnant people with SCD have lower blood pressure than unaffected pregnant people, raising the possibility that HDP are underdiagnosed, particularly in people with HbSS/HbSβ0 .
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Affiliation(s)
- Macy L. Early
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Amy Luo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore MD, USA
| | - Marissa Solow
- Division of Haematology, Department of Medicine, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Kristine Matusiak
- Division of Haematology, Department of Medicine, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Ahizechukwu C. Eke
- Division of Maternal-Fetal Medicine & Clinical Pharmacology
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadine Shehata
- Division of Hematology, Sinai Health System, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Phyllis August
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kevin H.M. Kuo
- Division of Haematology, Department of Medicine, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Ann Kinga Malinowski
- Division of Maternal-Fetal Medicine, Sinai Health System
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Saif Said AL Harthi S, Arulappan J, Al Yazeedi B, Al Zaabi AHS. Adverse pregnancy, fetal and neonatal outcomes in women with sickle cell disease in a Middle Eastern country. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057231220188. [PMID: 38308541 PMCID: PMC10838028 DOI: 10.1177/17455057231220188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Sickle cell disease in pregnancy is associated with high maternal and fetal mortality. However, studies reporting pregnancy, fetal, and neonatal outcomes in women with sickle cell disease are extremely limited. OBJECTIVES The objectives of the study are to determine whether women with sickle cell disease have a greater risk of adverse pregnancy, fetal, and neonatal outcomes than women without sickle cell disease and identify the predictors of adverse pregnancy, fetal, and neonatal outcomes in women with sickle cell disease. DESIGN A retrospective pair-matched case-control study was conducted to compare 171 pregnant women with sickle cell disease to 171 pregnant women without sickle cell disease in Muscat, Sultanate of Oman. METHODS All pregnant Omani women with sickle cell disease who delivered between January 2015 and August 2021 at Sultan Qaboos University Hospital and Royal Hospital, who were either primipara or multipara and who had a gestational age of 24-42 weeks, were included as patients, whereas women who had no sickle cell disease or any comorbidity during pregnancy, who delivered within the same timeframe and at the same hospitals, were recruited as controls. The data were retrieved from electronic medical records and delivery registry books between January 2015 and August 2021. RESULTS Women with sickle cell disease who had severe anemia had increased odds of (χ2 = 58.56, p < 0.001) having adverse pregnancy outcomes. Women with sickle cell disease had 21.97% higher odds of delivering a baby with intrauterine growth retardation (χ2 = 17.80, unadjusted odds ratio = 2.91-166.13, p < 0.001). Newborns born to women with sickle cell disease had 3.93% greater odds of being admitted to the neonatal intensive care unit (χ2 = 16.80, unadjusted odds ratio = 1.97-7.84, p < 0.001). In addition, the children born to women with sickle cell disease had 10.90% higher odds of being born with low birth weight (χ2 = 56.92, unadjusted odds ratio = 5.36-22.16, p < 0.001). Hemoglobin level (odds ratio = 0.17, p < 0.001, 95% confidence interval = 0.10-3.0), past medical history (odds ratio = 7.95, p < 0.001, 95% confidence interval = 2.39-26.43), past surgical history (odds ratio = 17.69, p < 0.001, 95% confidence interval = 3.41-91.76), and preterm delivery (odds ratio = 9.48, p = 0.005, 95% confidence interval = 1.95-46.23) were identified as predictors of adverse pregnancy, fetal, and neonatal outcomes in women with sickle cell disease. CONCLUSION As pregnant women with sickle cell disease are at increased risk for pregnancy, fetal, and neonatal adverse outcomes; improved antenatal surveillance and management may improve the outcomes.
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Affiliation(s)
| | - Judie Arulappan
- Department of Maternal and Child Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Basma Al Yazeedi
- Department of Maternal and Child Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
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Joseph L, Driessen M. A comprehensive view of pregnancy in patients with sickle cell disease in high-income countries: the need for robust data and further decline in morbidity and mortality. Lancet Haematol 2024; 11:e75-e84. [PMID: 38135375 DOI: 10.1016/s2352-3026(23)00310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023]
Abstract
Sickle cell disease is a major public health concern due to its prevalence and associated morbidities. In high-income countries, diagnosis and treatment advancements have extended patient's lives and enabled women to embrace motherhood. Although the provision of care in specialist centres has reduced maternal-fetal complication rates, the mortality rate among pregnant women with sickle cell disease remains disproportionately high. Complications arise from vaso-occlusive events, worsening organ damage, thrombotic risks, infections, and pregnancy-related issues, such as pre-eclampsia, premature birth, small-for-gestational-age, and pregnancy loss. Effective management during pregnancy includes preconception planning, genetic counselling, education, and collaborative care. There is no consensus on the overall approach to managing pregnant women with sickle cell disease; however, fostering a collaborative relationship between health-care professionals and researchers is crucial for advancing the understanding and management of this illness. The disparities in health-care outcomes associated with ethnicity and economic insecurity affect patients with sickle cell disease but have not been examined extensively. Hence, health-care personnel need sufficient training to address these issues alongside broader societal efforts to confront racism and discrimination. Comprehensive national and global action plans are required to address the multifaceted challenges of sickle cell disease.
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Affiliation(s)
- Laure Joseph
- Biotherapy Department, French National Sickle Cell Referral Centre, Biotherapy Clinical Investigation Centre, Hôpital Necker-Enfant Malades, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Marine Driessen
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfant Malades, Assistance-Publique Hôpitaux de Paris, Paris, France
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Shegekar T, Pajai S. A Comprehensive Review of Pregnancy in Sickle Cell Disease. Cureus 2023; 15:e41165. [PMID: 37525766 PMCID: PMC10387184 DOI: 10.7759/cureus.41165] [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] [Received: 10/20/2022] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
Sickle cell hemoglobinopathies encompass a range of qualitative and quantitative hemoglobin disorders that are inherited genetically. This group of disorders includes sickle cell beta thalassemia, sickle cell trait, and sickle cell disease (SCD). Globally, SCD is the most common disorder. Even epidemiological data suggests the majority of diseases, as well as traits, are concentrated in Sub-Saharan Africa, North-East Africa, the Middle East, and India. The physiological changes in pregnancy predispose to an increased risk of catastrophic events like a vaso-occlusive crisis, thromboembolic events, and their related sequelae, leading eventually to villous infarction, necrosis, and fibrosis leading to compromising uteroplacental circulation. Conversely, the mother may exhibit exacerbated symptoms of gestational hypertension, placental abruption, preterm labor, and venous thromboembolism. Although this disease is manageable, it has the potential to adversely impact maternal and child health on a national level. The chances of severe complications in the pregnant state affecting both mother and fetus attract due attention of health services towards redefining and researching this disease and its management frequently. The literature review on the following situation advocates the general treatment to be observed under the headings of preconceptual care, strengthened antenatal care, strict intranatal care, and compliant post-natal care. Preconceptually, genetic screening of couples, with education on the adverse effects of the disease, comes as the first line of management. Newer facilities like preimplantation genetic diagnosis and celocentesis may even allow for early diagnosis as well as help patients who do not wish to terminate the pregnancy by selective transfer of unaffected embryos. This may be combined with an extensive evaluation of the psychosocial aspect and socioeconomic status of couples who administer vaccines as prophylaxis for preventable diseases. Strengthening antenatal care is associated with routine blood investigations for every registered antenatal patient with adequate awareness about the conditions that precipitate the crisis. All patients should be prophylactically treated with appropriate doses of aspirin, iron, folic acid, and multivitamins. Radiological examinations by ultrasonography may be used to monitor placenta previa, abruption, or preterm labor. Later in pregnancy, it should be recommended to perform biophysical profiling and assessment of umbilical artery flow. Intranatal care deals with strict-term institutional delivery of all sickle cell-diseased mothers with a preference for vaginal delivery. Post-natal care requires a precise assessment of blood loss during labor to initiate transfusion therapy as soon as needed. Exclusive breastfeeding, with the importance of early initiation of it, must be emphasized. Screening of neonates as quickly as possible must be done for hemoglobinopathies. Through this review, authors are trying to make aware of the complications that can be faced during pregnancy in SCD patients, its prevention, and its treatment according to various new guidelines and research available.
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Affiliation(s)
- Tejas Shegekar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Seed PT, Brien SB, Oakley LL, Robinson V, Sharif J, Thompson H, Joseph J, Oteng-Ntim E. Serial prophylactic exchange blood transfusion in pregnant women with sickle cell disease (TAPS-2): statistical and qualitative analysis plan for a randomised controlled feasibility trial. Trials 2023; 24:225. [PMID: 36964626 PMCID: PMC10037353 DOI: 10.1186/s13063-023-07235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND There are significant knowledge gaps regarding the effectiveness of serial prophylactic exchange blood transfusion (SPEBT) for pregnant women with sickle cell disease (SCD). The protocol for the randomised feasibility trial assessing SPEBT versus usual care in women with SCD (TAPS2 trial) has previously been published. This publication outlines the statistical and qualitative analysis plan for the study. METHODS AND DESIGN TAPS2 is a randomised two-arm phase 2 feasibility trial with a nested qualitative study and health economic evaluation. Up to 50 pregnant women with SCD and a singleton pregnancy will be recruited and individually randomised to either SPEBT approximately every 6-10 weeks until delivery (intervention arm) or to usual care (control arm). Information will be collected on a range of feasibility and clinical outcomes. RESULTS Due to the impact of COVID-19 on study recruitment, the initial study period of 24 months was extended to 48 months. Other protocol updates designed to mitigate the impact of COVID-19-related disruption included allowing for remote consent and conducting all qualitative interviews by telephone. The primary outcome for the trial is the overall recruitment rate. The number of women screened, eligible, consented, randomised and withdrawn will be summarised as a CONSORT flow diagram. Differences in clinical outcomes will additionally be presented as an initial assessment of efficacy and to inform sample size calculations for a future definitive trial. Qualitative interviews with trial participants and clinicians will be analysed using reflexive thematic analysis; data from interviews with participants who declined to participate in the trial will be extracted and incorporated into summary tables to report key findings. The health economic analysis plan is not covered by this update. CONCLUSION The publication of this analysis plan is designed to aid transparency and to reduce the potential for reporting bias. TRIAL REGISTRATION NIH registry ( www. CLINICALTRIALS gov ), registration number NCT03975894 (registered 05/06/19); ISRCTN ( www.isrctn.com ), registration number ISRCTN52684446 (retrospectively registered 02/08/19).
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Affiliation(s)
- Paul T Seed
- Division of Women's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Sarah B Brien
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Laura L Oakley
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Centre for Fertility and Health, Norwegian Institute of Public Health, Skøyen, P.O. box 222, N-0213, Oslo, Norway.
| | - Vicky Robinson
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Joseph Sharif
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Hilary Thompson
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jeannine Joseph
- Patient author, c/o Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Eugene Oteng-Ntim
- Division of Women's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
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Adesina OO, Brunson A, Fisch SC, Yu B, Mahajan A, Willen SM, Keegan THM, Wun T. Pregnancy outcomes in women with sickle cell disease in California. Am J Hematol 2023; 98:440-448. [PMID: 36594168 PMCID: PMC9942937 DOI: 10.1002/ajh.26818] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Adverse pregnancy outcomes occur frequently in women with sickle cell disease (SCD) across the globe. In the United States, Black women experience disproportionately worse maternal health outcomes than all other racial groups. To better understand how social determinants of health impact SCD maternal morbidity, we used California's Department of Health Care Access and Information data (1991-2019) to estimate the cumulative incidence of pregnancy outcomes in Black women with and without SCD-adjusted for age, insurance status, and Distressed Community Index (DCI) scores. Black pregnant women with SCD were more likely to deliver at a younger age, use government insurance, and live in at-risk or distressed neighborhoods, compared to those without SCD. They also experienced higher stillbirths (26.8, 95% confidence interval [CI]: 17.5-36.1 vs. 12.4 [CI: 12.1-12.7], per 1000 births) and inpatient maternal mortality (344.5 [CI: 337.6-682.2] vs. 6.1 [CI: 2.3-8.4], per 100 000 live births). Multivariate logistic regression models showed Black pregnant women with SCD had significantly higher odds ratios (OR) for sepsis (OR 14.89, CI: 10.81, 20.52), venous thromboembolism (OR 13.60, CI: 9.16, 20.20), and postpartum hemorrhage (OR 2.25, CI 1.79-2.82), with peak onset in the second trimester, third trimester, and six weeks postpartum, respectively. Despite adjusting for sociodemographic factors, Black women with SCD still experienced significantly worse pregnancy outcomes than those without SCD. We need additional studies to determine if early introduction to reproductive health education, continuation of SCD-modifying therapies during pregnancy, and increasing access to multidisciplinary perinatal care can reduce morbidity in pregnant women with SCD.
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Affiliation(s)
- Oyebimpe O. Adesina
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Samantha C. Fisch
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Bo Yu
- Department of Obstetrics & Gynecology, Stanford University School of Medicine; Stanford Maternal & Child Health Research Institute, Stanford, CA
| | - Anjlee Mahajan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Shaina M. Willen
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- Division of Pediatric Pulmonary and Sleep Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Theresa H. M. Keegan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- UC Davis Clinical and Translational Science Center, University of California, Davis, CA
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Habibi A, Cannas G, Bartolucci P, Voskaridou E, Joseph L, Bernit E, Gellen-Dautremer J, Charneau C, Ngo S, Galactéros F. Outcomes of Pregnancy in Sickle Cell Disease Patients: Results from the Prospective ESCORT-HU Cohort Study. Biomedicines 2023; 11:biomedicines11020597. [PMID: 36831132 PMCID: PMC9953329 DOI: 10.3390/biomedicines11020597] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
Sickle cell disease (SCD) refers to a group of inherited hemoglobin disorders in which sickle red blood cells display altered deformability, leading to a significant burden of acute and chronic complications, such as vaso-occlusive pain crises (VOCs). Hydroxyurea is a major therapeutic agent in adult and pediatric sickle cell patients. This treatment is an alternative to transfusion in some complications. Indeed, it increases hemoglobin F and has an action on the endothelial adhesion of red blood cells, leukocytes, and platelets. Although the safety profile of hydroxyurea (HU) in patients with sickle cell disease has been well established, the existing literature on HU exposure during pregnancy is limited and incomplete. Pregnancy in women with SCD has been identified as a high risk for the mother and fetus due to the increased incidence of maternal and non-fetal complications in various studies and reports. For women on hydroxyurea at the time of pregnancy, transfusion therapy should probably be initiated after pregnancy. In addition, there is still a significant lack of knowledge about the incidence of pregnancy, fetal and maternal outcomes, and management of pregnant women with SCD, making it difficult to advise women or clinicians on outcomes and best practices. Therefore, the objective of this study was to describe pregnancy outcomes (n = 128) reported in the noninterventional European Sickle Cell Disease COhoRT-HydroxyUrea (ES-CORT-HU) study. We believe that our results are important and relevant enough to be shared with the scientific community.
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Affiliation(s)
- Anoosha Habibi
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, U-PEC, 94000 Créteil, France
- INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule Rouge, Laboratoire d’Excellence GR-Ex, 94000 Créteil, France
- Correspondence:
| | | | - Pablo Bartolucci
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, U-PEC, 94000 Créteil, France
- INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule Rouge, Laboratoire d’Excellence GR-Ex, 94000 Créteil, France
| | - Ersi Voskaridou
- Thalassemia and Sickle Cell Disease Center, “Laiko” General Hospital, 115 27 Athens, Greece
| | - Laure Joseph
- Biotherapy Department, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, 75610 Paris, France
| | - Emmanuelle Bernit
- Sickle Cell Referral Center, CHU Guadeloupe-Pôle Parents-Enfants—Hôpital Ricou, BP465, Pointe à Pitre, CEDEX, 97159 Guadeloupe, France
| | | | | | | | - Frédéric Galactéros
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, U-PEC, 94000 Créteil, France
- INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule Rouge, Laboratoire d’Excellence GR-Ex, 94000 Créteil, France
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11
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Hafiani EM, Dupeyrat S, Quesnel C. Prise en charge périopératoire du patient adulte drépanocytaire. ANESTHÉSIE & RÉANIMATION 2023. [DOI: 10.1016/j.anrea.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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12
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Evidence-based management of pregnant women with sickle cell disease in high-income countries. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:408-413. [PMID: 36485166 PMCID: PMC9820817 DOI: 10.1182/hematology.2022000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Globally, patients living with sickle cell disease are now surviving to reproductive age, with life expectancy approaching 50 years in most countries. Thus, reproductive options are now essential for patients living with the condition. However, it can be associated with maternal, delivery, and fetal complications. Outcomes may vary depending on the level of expertise and resources. In this piece we provide an optional guideline for managing sickle cell disease in pregnancy. The therapeutic option of serial exchange prophylactic transfusion has been offered in the context of a clinical trial (TAPS2).
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13
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Moukalled NM, Bou Fakhredin R, Taher AT. Pregnancy and sickle cell disease: an overview of complications and suggested perinatal care. Expert Rev Hematol 2022; 15:1055-1061. [PMID: 36413684 DOI: 10.1080/17474086.2022.2151432] [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: 11/24/2022]
Abstract
INTRODUCTION Pregnancy in women with sickle cell disease (SCD) has been identified as high risk owing to increased incidence of materno-fetal complications across various studies and reports. These complications include consequences related to the underlying hemoglobinopathy; chronic anemia/associated inflammation, and pregnancy related including the risk for thromboembolism, bleeding and maternal mortality. Outcomes of neonates born to women with SCD has been suboptimal over the years with recent improvement due to strict monitoring, preventive and therapeutic measures. Much is yet to be unraveled regarding the optimal management of women with SCD during pregnancy, identifying target hemoglobin, delivery mode or timing among others. AREAS COVERED This review includes a summary of available data of the maternal and fetal outcomes; in addition to current recommendations for monitoring and management of women with SCD during pregnancy. EXPERT OPINION To have a successful pregnancy, women should be closely monitored, and interventions provided as needed to guarantee adequate management of anemia, as well as prevention, diagnosis and management of disease. They should also be educated regarding their reproductive health, emphasizing that pregnancy is possible, and achieving optimal results depends on providing adequate care in a health care facility with expertise in high-risk pregnancies and SCD.
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Affiliation(s)
- Nour M Moukalled
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Bou Fakhredin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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14
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Dickerhoff R. [The broad spectrum of sickle cell disease: HbSC in everyday clinical practice]. Dtsch Med Wochenschr 2022; 147:1259-1266. [PMID: 36126924 DOI: 10.1055/a-1767-8315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Sickle cell disease has come to Germany from the Mediterranean region, Africa and the Middle East since the 1950 s and initially mainly concerned paediatricians. Since the 1970 s, the life expectancy of those affected has risen significantly, and about 95 % now live to adulthood. Therefore, general practitioners and internists should be familiar with the different forms of sickle cell disease, especially HbSC disease (approx. 20 %).A precise diagnosis of sickle cell disease (exact phenotype) is essential; the term "sickle cell anaemia" must be avoided. In patients of African origin with microcytosis, slightly elevated reticulocytes and pain symptomatology, the possibility of HbSC disease should be considered - even with age-appropriate haemoglobin values. Annual retinoscopy is recommended for HbSC patients from the age of 7, and for all other sickle cell patients from the age of 10. If a hearing loss occurs in an HbSC patient, phlebotomy should be performed immediately. In all sickle cell patients with dizziness or pain and an Hb > 10 g/dl, phlebotomy is indicated.
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15
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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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16
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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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17
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Gastrointestinal Vasoocclusive Crisis in a Woman with Hemoglobin SC Disease. Am J Med 2022; 135:592-594. [PMID: 35026137 DOI: 10.1016/j.amjmed.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/21/2022]
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18
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Stoddard K, Sohal M, Bedson R. Anaesthetic management of patients with sickle cell disease in obstetrics. BJA Educ 2022; 22:87-93. [PMID: 35211325 PMCID: PMC8847837 DOI: 10.1016/j.bjae.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- K. Stoddard
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M. Sohal
- Imperial College Healthcare NHS Trust, London, UK
| | - R. Bedson
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK,Corresponding author.
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19
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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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20
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Mégier C, Peoc’h K, Puy V, Cordier AG. Iron Metabolism in Normal and Pathological Pregnancies and Fetal Consequences. Metabolites 2022; 12:metabo12020129. [PMID: 35208204 PMCID: PMC8876952 DOI: 10.3390/metabo12020129] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
Iron is required for energy production, DNA synthesis, and cell proliferation, mainly as a component of the prosthetic group in hemoproteins and as part of iron-sulfur clusters. Iron is also a critical component of hemoglobin and plays an important role in oxygen delivery. Imbalances in iron metabolism negatively affect these vital functions. As the crucial barrier between the fetus and the mother, the placenta plays a pivotal role in iron metabolism during pregnancy. Iron deficiency affects 1.2 billion individuals worldwide. Pregnant women are at high risk of developing or worsening iron deficiency. On the contrary, in frequent hemoglobin diseases, such as sickle-cell disease and thalassemia, iron overload is observed. Both iron deficiency and iron overload can affect neonatal development. This review aims to provide an update on our current knowledge on iron and heme metabolism in normal and pathological pregnancies. The main molecular actors in human placental iron metabolism are described, focusing on the impact of iron deficiency and hemoglobin diseases on the placenta, together with normal metabolism. Then, we discuss data concerning iron metabolism in frequent pathological pregnancies to complete the picture, focusing on the most frequent diseases.
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Affiliation(s)
- Charles Mégier
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Bicêtre, Université Paris Saclay, 94270 Le Kremlin-Bicetre, France;
| | - Katell Peoc’h
- Assistance Publique-Hôpitaux de Paris, Laboratoire de Biochimie Clinique, HUPNVS, Hôpital Beaujon, Clichy and Université de Paris, UFR de Médecine Xavier Bichat, INSERM U1149, F-75018 Paris, France;
| | - Vincent Puy
- Unité de biologie de la Reproduction CECOS, Hôpital Antoine Béclère, Université Paris Saclay, 92140 Clamart, France;
- Laboratoire de Développement des Gonades, UMRE008 Stabilité Génétique Cellules Souches et Radiations, Université de Paris, Université Paris-Saclay, CEA, F-92265 Fontenay-aux-Roses, France
| | - Anne-Gaël Cordier
- INSERM, 3PHM, UMR-S1139, F-75006 Paris, France
- PremUp Foundation, F-75014 Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, Université Paris-Saclay, 92140 Clamart, France
- Correspondence: ; Tel.: +33-145374441; Fax: +33-45374366
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21
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Bedrick BS, Kohn TP, Pecker LH, Christianson MS. Fertility preservation for pediatric patients with hemoglobinopathies: Multidisciplinary counseling needed to optimize outcomes. Front Endocrinol (Lausanne) 2022; 13:985525. [PMID: 36353243 PMCID: PMC9638952 DOI: 10.3389/fendo.2022.985525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/30/2022] [Indexed: 01/19/2023] Open
Abstract
Hemoglobinopathies are autosomal recessive disorders that occur when genetic mutations negatively impact the function of hemoglobin. Common hemoglobinopathies that are clinically significant include sickle cell disease, alpha thalassemia, and beta thalassemia. Advancements in disease-modifying and curative treatments for the common hemoglobinopathies over the past thirty years have led to improvements in patient quality of life and longevity for those who are affected. However, the diseases, their treatments and cures pose infertility risks, making fertility preservation counseling and treatment an important part of the contemporary comprehensive patient care. Sickle cell disease negatively impacts both male and female infertility, primarily by testicular failure and decreased ovarian reserve, respectively. Fertility in both males and females with beta thalassemia major are negatively impacted by iron deposition due to chronic blood transfusions. Hematopoietic stem cell transplant (HSCT) is currently the only curative treatment for SCD and transfusion dependent beta thalassemia. Many of the conditioning regimens for HSCT contain chemotherapeutic agents with known gonadotoxicity and whole-body radiation. Although most clinical studies on toxicity and impact of HSCT on long-term health do not evaluate fertility, gonadal failure is common. Male fertility preservation modalities that exist prior to gonadotoxic treatment include sperm banking for pubertal males and testicular cryopreservation for pre-pubertal boys. For female patients, fertility preservation options include oocyte cryopreservation and ovarian tissue cryopreservation. Oocyte cryopreservation requires controlled ovarian hyperstimulation (COH) with ten to fourteen days of intensive monitoring and medication administration. This is feasible once the patient has undergone menarche. Follicular growth is monitored via transvaginal or transabdominal ultrasound, and hormone levels are monitored through frequent blood work. Oocytes are then harvested via a minimally invasive approach under anesthesia. Complications of COH are more common in patients with hemoglobinopathies. Ovarian hyperstimulation syndrome creates a greater risk to patients with underlying vascular, pulmonary, and renal injury, as they may be less able to tolerate fluids shifts. Thus, it is critical to monitor patients undergoing COH closely with close collaboration between the hematology team and the reproductive endocrinology team. Counseling patients and families about future fertility must take into consideration the patient's disease, treatment history, and planned treatment, acknowledging current knowledge gaps.
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Affiliation(s)
- Bronwyn S. Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Taylor P. Kohn
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lydia H. Pecker
- Department of Medicine, Division of Adult Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mindy S. Christianson
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Mindy S. Christianson,
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22
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McCaw-Binns A, Campbell L, Harris A, James LA, Asnani M. Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998-2017). EClinicalMedicine 2022; 43:101238. [PMID: 34977515 PMCID: PMC8683691 DOI: 10.1016/j.eclinm.2021.101238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998-2007 their maternal mortality ratio was 7-11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care. METHODS Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open. FINDINGS Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with (p = 0.502) and without SCD (p = 0.629). The MMR among women with and without SCD in 2008-17 was 378.1 (n = 41) and 89.2/100,000 live births (n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07-5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36-3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051). INTERPRETATION MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children. FUNDING No external funding was provided.
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Affiliation(s)
- Affette McCaw-Binns
- Department of Community Health & Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Leroy Campbell
- Victoria Jubilee Hospital, South-East Regional Health Authority, North Street, Kingston, Jamaica
| | - Ardene Harris
- Ministry of Health & Wellness, Epidemiology Unit, 10-16 Grenada Crescent, Kingston 5, Jamaica
| | - Lesley-Ann James
- Ministry of Health & Wellness, Epidemiology Unit, 10-16 Grenada Crescent, Kingston 5, Jamaica
| | - Monika Asnani
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the Indies, Mona Campus, Kingston 7, Jamaica
- Corresponding author at: Sickle Cell Unit, Caribbean Institute for Health Research, The University of the Indies, Mona Campus, Kingston 7, Jamaica.
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23
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Oakley LL, Mitchell S, von Rege I, Hadebe R, Howard J, Robinson SE, Oteng-Ntim E. Perinatal outcomes in women with sickle cell disease: a matched cohort study from London, UK. Br J Haematol 2021; 196:1069-1075. [PMID: 34881428 DOI: 10.1111/bjh.17983] [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: 09/09/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
There are limited data on contemporary outcomes for women with sickle cell disease (SCD) in pregnancy. We conducted a single-site matched cohort study, comparing 131 pregnancies to women with SCD between 2007 and 2017 to a comparison group of 1310 pregnancies unaffected by SCD. Restricting our analysis to singleton pregnancies that reached 24 weeks of gestation, we used conditional Poisson regression to estimate adjusted risk ratios (aRRs) for perinatal outcomes. Infants born to mothers with SCD were more likely to be small for gestational age [aRR 1·69, 95% confidence interval (CI) 1·13-2·48], preterm (aRR 2·62, 95% CI 1·82-3·78) and require Neonatal Unit (NNU) admission (aRR 3·59, 95% CI 2·18-5·90). Pregnant women with SCD were at higher risk of pre-eclampsia/eclampsia (aRR 3·53, 95% CI 2·00-6·24), more likely to receive induction of labour (aRR 2·50, 95% CI 1·82-1·76) and caesarean birth (aRR 1·44, 95% CI 1·18-1·76). In analysis stratified by genotype, the risk of adverse outcomes was highest in haemoglobin SS (HbSS) pregnancies (n = 80). There was no strong evidence that haemoglobin SC (HbSC) pregnancies (n = 46) were at higher risk of preterm birth, caesarean delivery, or NNU admission. Pre-eclampsia/eclampsia was more frequently observed in HbSC pregnancies. Despite improvements in the care of pregnant women with SCD, the increased risk of adverse perinatal outcomes remains.
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Affiliation(s)
- Laura L Oakley
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sian Mitchell
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Inez von Rege
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruth Hadebe
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jo Howard
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Susan E Robinson
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
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24
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Oteng-Ntim E, Pavord S, Howard R, Robinson S, Oakley L, Mackillop L, Pancham S, Howard J. Management of sickle cell disease in pregnancy. A British Society for Haematology Guideline. Br J Haematol 2021; 194:980-995. [PMID: 34409598 DOI: 10.1111/bjh.17671] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Eugene Oteng-Ntim
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- Department of Women's Health, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Sue Pavord
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Richard Howard
- Department of Obstetrics and Gynaecology, Barking, Havering and Redbridge University Hospitals, Romford, United Kingdom of Great Britain and Northern Ireland
| | - Susan Robinson
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Laura Oakley
- London School of Hygiene and Tropical Medicine, London, United Kingdom of Great Britain and Northern Ireland
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lucy Mackillop
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Shivan Pancham
- Department of Haematology, Sandwell and West, Birmingham Hospitals NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Jo Howard
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- Department of Haematology, King's College London, London, United Kingdom of Great Britain and Northern Ireland
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25
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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: 6] [Impact Index Per Article: 2.0] [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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Malinowski AK, Kuo KHM, Tomlinson GA, Palcu P, Ward R, Shehata N. Distinct maternal and fetal pregnancy outcomes in women with sickle cell disease can be predicted using routine clinical and laboratory data. Br J Haematol 2021; 194:1063-1073. [PMID: 34124774 PMCID: PMC8518407 DOI: 10.1111/bjh.17607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
We aimed to identify risk factors for adverse outcomes in pregnancies of women with sickle cell disease (SCD) and develop risk prediction models. Models were derived from a retrospective cohort of pregnant women with SCD and constructed using generalised estimating equation logistic regression, with clustering by woman. Maternal event(s) consisted of acute anaemia; cardiac, pulmonary, hepatobiliary, musculoskeletal, skin, splenic, neurological or renal complications, multi‐organ failure, venous thromboembolism, admission‐requiring vaso‐occlusive events (VOE), red cell transfusion, mortality or hypertensive disorder of pregnancy. Fetal events included preterm birth, small‐for‐gestational‐age or perinatal mortality. Of 199 pregnancies, 71% and 45% resulted in adverse maternal and fetal outcomes respectively. Low first‐trimester haemoglobin, admission‐requiring VOE in the year before pregnancy, multiple transfusions before pregnancy, SCD genotype and previous cardiac complications predicted maternal risk. Younger age and SCD genotype allowed early prediction of fetal risk (model‐F1). Adding maternal event(s) and high lactate dehydrogenase enabled re‐assessment of fetal risk with advancing gestation (model‐F2). Models were well calibrated and moderately discriminative for maternal outcome (c‐statistic 0·81, cross‐validated value 0·79) and fetal outcome (model‐F1 c‐statistic 0·68, cross‐validated value 0·65; model‐F2 c‐statistic 0·72, cross‐validated value 0·68). The models will allow early identification of women with SCD at high risk of adverse events, permitting early targeted interventions and ongoing fetal risk re‐assessment enabling intensification of surveillance and optimisation of delivery timing.
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Affiliation(s)
- A Kinga Malinowski
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin H M Kuo
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology and Haematology, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - George A Tomlinson
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Patricia Palcu
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Ward
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology and Haematology, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Nadine Shehata
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology and Haematology, Department of Medicine, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Haematology, Mount Sinai Hospital, Toronto, ON, Canada
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27
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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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28
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Oluwaseyi BE, Michael OA, Oluwafemi AE, David AB. Pregnancy associated coagulopathies in selected community hospitals in Southwest Nigeria. J Family Med Prim Care 2021; 10:1614-1620. [PMID: 34123901 PMCID: PMC8144756 DOI: 10.4103/jfmpc.jfmpc_1381_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/12/2020] [Accepted: 01/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Aim: Pregnancy is characterized by multiple changes in the coagulation system which occurs at different stages of the condition, representing one of the major triggers of maternal and foetal morbidity/mortality in the world during complicated incidences. This study determined the prevalence of coagulation disorders among pregnant women in Southwest Nigeria to buttress the need for prompt and accurate routine diagnosis of these disorders. Methods: Four hundred and five participants (405) attending some selected tertiary health facilities in Southwestern Nigeria were randomly recruited for the study, comprising two hundred and seventy (270) pregnant subjects and one hundred and thirty-five (135) apparently healthy age- and socio-economic status-matched non-pregnant women as controls. The platelet count was assessed; prothrombin time and activated partial thromboplastin time were assessed. Immunoturbidimetric and chromogenic techniques were also used to assess the level of D-dimer and activated protein C resistance. Results: Platelet count, PT and INR in all three trimesters were significantly (p < 0.05) reduced when compared to the non-pregnant control subjects. However, the level of circulating D-dimer was significantly (p < 0.05) increased in all three trimesters when compared with the control group, with observable steady increase in the second and third trimesters. Also, 13% of respondents had thrombotic predisposition and 14.8% with tendencies for consumption coagulopathy while 1.1% are APCr positive individuals. Conclusion: The study affirms the hypercoagulable state of pregnancy coupled with mild gestational thrombocytopenia which could be pointers to onset of coagulation disorders in some participants, subjects with coagulation profiles indicative of thrombotic tendencies and possible onset of consumption coagulopathy and the presence of activated protein C resistant in the region. A review of the coagulation monitoring strategies for pregnant women from primary care to include more definite assays and its proper implementation will immensely contribute to early diagnosis along with intervention for pregnancy associated coagulopathies in resource-limited settings.
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Affiliation(s)
- Bamisaye E Oluwaseyi
- Department of Biomedical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Okungbowa A Michael
- Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - Akanni E Oluwafemi
- Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Ladoke Akintola University of Technology, Osogbo, Osun State, Nigeria
| | - Akinbo B David
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
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Walker I, Trompeter S, Howard J, Williams A, Bell R, Bingham R, Bankes M, Vercueil A, Dalay S, Whitaker D, Elton C. Guideline on the peri-operative management of patients with sickle cell disease: Guideline from the Association of Anaesthetists. Anaesthesia 2021; 76:805-817. [PMID: 33533039 DOI: 10.1111/anae.15349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
Sickle cell disease is a multisystem disease characterised by chronic haemolytic anaemia, painful vaso-occlusive crises and acute and chronic end-organ damage. It is one of the most common serious inherited single gene conditions worldwide and has a major impact on the health of affected individuals. Peri-operative complications are higher in patients with sickle cell disease compared with the general population and may be sickle or non-sickle-related. Complications may be reduced by meticulous peri-operative care and transfusion, but unnecessary transfusion should be avoided, particularly to reduce the risk of allo-immunisation. Planned surgery and anaesthesia for patients with sickle cell disease should ideally be undertaken in centres with experience in caring for these patients. In an emergency, advice should be sought from specialists with experience in sickle cell disease through the haemoglobinopathy network arrangements. Emerging data suggest that patients with sickle cell disease are at increased risk of COVID-19 infection but may have a relatively mild clinical course. Outcomes are determined by pre-existing comorbidities, as for the general population.
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Affiliation(s)
- I Walker
- Working Party, on behalf of the Association of Anaesthetists
| | - S Trompeter
- Department of Haematology, University College London NHS Foundation Trust and NHS Blood and Transplant, London, UK
| | - J Howard
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Williams
- Department of Anaesthesia, Bart's Health NHS Trust, London, UK
| | - R Bell
- Department of Anaesthesia, University College London NHS Foundation Trust, London, UK
| | - R Bingham
- 6Department of Paediatric Anaesthesia, Great Ormond Street Hospital NHS Trust and Association of Paediatric Anaesthetists of Great Britain and Ireland, London, UK
| | - M Bankes
- Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Vercueil
- Department of Anaesthesia, Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - S Dalay
- Department of Anaesthesia, Worcestershire Acute Hospitals NHS Trust UK and Association of Anaesthetists Trainee Committee
| | - D Whitaker
- Manchester and Royal College of Anaesthetists
| | - C Elton
- Department of Anaesthesia, University Hospitals of Leicester NHS Trust and Obstetric Anaesthetists' Association, Leicester, UK
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30
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Galiba Atipo Tsiba FO, Itoua C, Ehourossika C, Ngakegni NY, Buambo G, Potokoue Mpia NSB, Elira Dokekias A. Pregnancy Outcomes among Patients with Sickle Cell Disease in Brazzaville. Anemia 2020; 2020:1989134. [PMID: 33014460 PMCID: PMC7512036 DOI: 10.1155/2020/1989134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is one of the most common genetic diseases in the world. It combines, in its homozygous form, chronic hemolytic anemia, vasoocclusive complications, and susceptibility to infections. It is well known that the combination of pregnancy and sickle cell disease promotes the occurrence of complications that are sometimes fatal for the mother and/or the fetus. OBJECTIVE The objective of the current study was to compare pregnancy outcomes among women with SCD with those of women without the diagnosis of SCD. Materials and methods. It was a case-control study carried out in four maternity hospitals in Brazzaville in 2 years (July 2017-June 2019). It concerned 65 parturients with SS homozygous SCD. The mode of childbirth and maternal and perinatal morbidity and mortality were compared with those of 130 non-sickle cell pregnant women. RESULTS The average age was 27 years for SCD women and 31 years for non-SCD women. The average gestational age at delivery was 35 weeks for SCD women and 38 weeks for non-SCD women. From the logistic regression analysis using the comparison group as the reference group, there was excessive risk in SCD compared to non-SCD of infection (29.3% vs. 4.6%, OR = 21.7, 95% CI [7.6-62.7]; p=0.001), cesarean (63% vs. 35.4%, OR = 3.1, 95% CI [1.6-5.7]; p=0.001), prematurity (75.4% vs. 30.8%, OR = 8, 95% CI [3.0-23.2]; p=0.001), low birth weight (52.3% vs. 16.1%, OR = 4.7, 95% CI [2.4-9.4]; p=0.001), neonatal requiring admission to the intensive care unit (40.3% vs. 17.5%, OR = 3.2, 95% CI [1.6-6.3]; p=0.01), and neonatal death (21.5% vs. 4.8%, OR = 4.3, 95% CI [1.5-12.2]; p=0.01). CONCLUSION The risk of pregnancy in patients with homozygous sickle cell anemia remains high, on both the maternal and fetal sides.
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Affiliation(s)
- F. O. Galiba Atipo Tsiba
- Hematology Department, University Hospital of Brazzaville (Congo), Brazzaville, Congo
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville (Congo), Brazzaville, Congo
| | - C. Itoua
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville (Congo), Brazzaville, Congo
- Gynecology-Obstetrics Department, University Hospital of Brazzaville (Congo), Brazzaville, Congo
| | - C. Ehourossika
- Gynecology-Obstetrics Department, University Hospital of Brazzaville (Congo), Brazzaville, Congo
| | - N. Y. Ngakegni
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville (Congo), Brazzaville, Congo
- Pediatric Department, University Hospital of Brazzaville (Congo), Brazzaville, Congo
| | - G. Buambo
- Gynecology-Obstetrics Department, University Hospital of Brazzaville (Congo), Brazzaville, Congo
| | - N. S. B. Potokoue Mpia
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville (Congo), Brazzaville, Congo
- Gynecology-Obstetrics Department, University Hospital of Brazzaville (Congo), Brazzaville, Congo
| | - A. Elira Dokekias
- Hematology Department, University Hospital of Brazzaville (Congo), Brazzaville, Congo
- Faculty of Health Sciences, Marien Ngouabi University of Brazzaville (Congo), Brazzaville, Congo
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31
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Cordier AG, Bouvier AS, Vibert F, Martinovic J, Couturier-Tarrade A, Lai-Kuen R, Curis E, Fournier T, Benachi A, Peoc'H K, Gil S. Preserved efficiency of sickle cell disease placentas despite altered morphology and function. Placenta 2020; 100:81-88. [PMID: 32871493 DOI: 10.1016/j.placenta.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pregnant women with sickle cell disease (SCD) are at high risk for sickle cell-related complications, obstetrical complications, and perinatal morbidity. Chronic inflammation and the proangiogenic environment associated with SCD have been associated with endothelial damage. It is unknown whether SCD complications could be associated with placental dysfunction or abnormal placental morphology. Moreover, circulating angiogenic factors in pregnant women with SCD are unexplored. METHODS Clinical records, placental and blood samples were collected at term delivery for 21 pregnant patients with SCD and 19 HbAA pregnant controls with adapted to gestational age birth weight newborns. Histological and stereological analyses and scanning electron microscopy (SEM) of the placenta, and PlGF and sFlt1 measurements in blood were performed. RESULTS In the SCD group, the parenchyma-forming villi of placentas were thinner than in controls, and increased fibrinoid necrosis and an overabundance of syncytial knots were seen. SEM revealed elongated intermediate villous endings with a reduction in the number of terminal villi compared to controls, indicating a significant branching defect in SCD placentas. Finally, SCD patients had an imbalance in the angiogenic ratio of sFlt1/PlGF (p = 0.008) with a drop of PlGF concentrations. DISCUSSION We evidence for the first time both abnormal placenta morphology and altered sFlt1/PlGF ratio in SCD patients, uncorrelated with maintained placental efficiency and fetal growth.
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Affiliation(s)
- Anne-Gael Cordier
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie Obstétrique, Centre hospitalier universitaire Antoine Béclère, Université Paris-Sud, 92140, Clamart, France; Université de Paris, INSERM UMR-S1139 (3PHM), Sorbonne Paris Cité, Paris, F-75006, France; PremUp Foundation, Paris, F-75014, France; Centre de référence maladies rares. Syndromes drépanocytaires majeurs, thalassémies et autres pathologies rares du globule rouge et de l'érythropoïèse, Paris, France.
| | - Anne-Sophie Bouvier
- Université de Paris, INSERM UMR-S1139 (3PHM), Sorbonne Paris Cité, Paris, F-75006, France; PremUp Foundation, Paris, F-75014, France
| | - Francoise Vibert
- Université de Paris, INSERM UMR-S1139 (3PHM), Sorbonne Paris Cité, Paris, F-75006, France; PremUp Foundation, Paris, F-75014, France
| | - Jelena Martinovic
- Assistance Publique-Hôpitaux de Paris, Service de Fœtopathologie, Centre hospitalier universitaire Antoine Béclère, Université Paris-Sud, Clamart, France; INSERM, UMR, 1195, Université Paris Sud, Paris Saclay, France
| | | | - René Lai-Kuen
- Plateau technique Imagerie Cellulaire et Moléculaire (ICM), UMS, 3612, CNRS, US25 INSERM, Faculté de Pharmacie de Paris, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Emmanuel Curis
- Service de biostatistiques et informatique médicale, Hôpital Saint-Louis, APHP, Paris, France; Laboratoire de biomathématiques, Faculté de pharmacie, Université Paris Descartes, France
| | - Thierry Fournier
- Université de Paris, INSERM UMR-S1139 (3PHM), Sorbonne Paris Cité, Paris, F-75006, France
| | - Alexandra Benachi
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie Obstétrique, Centre hospitalier universitaire Antoine Béclère, Université Paris-Sud, 92140, Clamart, France; Centre de référence maladies rares. Syndromes drépanocytaires majeurs, thalassémies et autres pathologies rares du globule rouge et de l'érythropoïèse, Paris, France
| | - Katell Peoc'H
- Université de Paris, INSERM UMR-S1139 (3PHM), Sorbonne Paris Cité, Paris, F-75006, France; Assistance Publique-Hôpitaux de Paris, Laboratoire de Biochimie Clinique, HUPNVS, Hôpital Beaujon, Clichy and Université de Paris, UFR de Médecine Xavier Bichat, Paris, France
| | - Sophie Gil
- Université de Paris, INSERM UMR-S1139 (3PHM), Sorbonne Paris Cité, Paris, F-75006, France; PremUp Foundation, Paris, F-75014, France
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Abstract
Rare inherited anemias are a subset of anemias caused by a genetic defect along one of the several stages of erythropoiesis or in different cellular components that affect red blood cell integrity, and thus its lifespan. Due to their low prevalence, several complications on growth and development, and multi-organ system damage are not yet well defined. Moreover, during the last decade there has been a lack of proper understanding of the impact of rare anemias on maternal and fetal outcomes. In addition, there are no clear-cut guidelines outlining the pathophysiological trends and management options unique to this special population. Here, we present on behalf of the European Hematology Association, evidence- and consensus-based guidelines, established by an international group of experts in different fields, including hematologists, gynecologists, general practitioners, medical geneticists, and experts in rare inherited anemias from various European countries for standardized and appropriate choice of therapeutic interventions for the management of pregnancy in rare inherited anemias, including Diamond-Blackfan Anemia, Congenital Dyserythropoietic Anemias, Thalassemia, Sickle Cell Disease, Enzyme deficiency and Red cell membrane disorders.
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Montironi R, Cupaiolo R, Kadji C, Badr DA, Deleers M, Charles V, Vanderhulst J, El Kenz H, Jani JC. Management of sickle cell disease during pregnancy: experience in a third-level hospital and future recommendations. J Matern Fetal Neonatal Med 2020; 35:2345-2354. [PMID: 32627603 DOI: 10.1080/14767058.2020.1786054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To describe the outcomes of sickle-cell disease in pregnancy according to the different treatments adopted before and during pregnancy and to propose a systematic approach to treat sickle-cell disease (SCD) during pregnancy.Methods: A retrospective descriptive study compared pregnancy outcomes among women with SCD who stopped hydroxyurea (HU) once pregnant (Group 1), were never treated before and during pregnancy (Group 2) or were treated by HU before conception who received prophylactic transfusion during pregnancy (Group 3). For each group we recorded the population's characteristics and the transfusion-related, obstetrical, perinatal and SCD complications.Results: We found 11 patients for group 1 (9/11 with at least 3 painful crises during the 12 months before conception), 4 for group 2 (3/4 with no sickle-cell complications during the year before pregnancy) and 2 for group 3 (one with previous multiorgan failure (MOF), one with previous stroke). No transfusion-related complication occurred. Group 1 and 2 developed SCD complications and a high number of acute transfusions and hospital admissions. Group 3 showed none of these complications, but one patient developed preeclampsia and preterm birth. Several obstetrical and perinatal complications occurred in group 1.Conclusion: Not treating sickle-cell during pregnancy increases maternal and perinatal morbidity, even in mildly affected women. All sickle-cell pregnancies should be treated, according to the treatment adopted before but also to patient's SCD-history. We propose chronic transfusion to women with previous stroke or MOF or already under transfusion program, and HU for severely and mildly affected patients, respectively from the second and third trimesters. Additional prospective studies are needed to validate the results of the proposed protocol.
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Affiliation(s)
- Ramona Montironi
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Roberto Cupaiolo
- Department of Blood Transfusion, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Deleers
- Department of Blood Transfusion, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Valérie Charles
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Julien Vanderhulst
- Department of Internal Medicine, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Hanane El Kenz
- Department of Blood Transfusion, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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34
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Inparaj S, Buckingham M, Oakley L, Seed PT, Lucas S, Oteng-Ntim E. Pulmonary complications for women with sickle cell disease in pregnancy: systematic review and meta-analysis. Thorax 2020; 75:568-575. [PMID: 32345690 DOI: 10.1136/thoraxjnl-2019-213796] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a multisystem disease characterised by vaso-occlusive crisis, chronic anaemia and a shorter lifespan. More patients with SCD are living till reproductive age and contemplating pregnancy. Pulmonary complications in pregnancy are significant causes of maternal morbidity and mortality but yet this has not been systematically quantified. A systematic review and meta-analysis were conducted to quantify the association between SCD and pulmonary complications in pregnancy. METHODS MEDLINE, EMBASE, Web of Science, Cochrane and Maternity and Infant Care databases were searched for publications between January 1998 and April 2019. Observational studies involving at least 30 participants were included. Random-effects models were used for statistical meta-analysis. FINDINGS Twenty-two studies were included in the systematic review and 18 in the quantitative analysis. The meta-analysis included 3964 pregnancies with SCD and 336 559 controls. Compared with women without SCD, pregnancies complicated by SCD were at increased risk of pulmonary thromboembolism (relative risk (RR) 7.74; 95% CI 4.65 to 12.89). The estimated prevalence of acute chest syndrome and pneumonia was 6.46% (95% CI 4.66% to 8.25%), with no significant difference between the HbSS and HbSC genotypes (RR 1.42; 95% CI 0.90 to 2.23). INTERPRETATION This meta-analysis highlighted a strong association between SCD and maternal pulmonary complications. Understanding the risks of and the factors associated with pulmonary complications would aid preconceptual counselling and optimal management of the condition in pregnancy, thereby reducing associated maternal morbidity and mortality. PROSPERO REGISTRATION NUMBER CRD42019124708.
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Affiliation(s)
- Sivarajini Inparaj
- Women's and Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mickey Buckingham
- Women's and Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Laura Oakley
- Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Paul T Seed
- Division of Reproduction and Endocrinology, Kings College London, London, UK
| | - Sebastian Lucas
- Department of Histopathology, KCL School of Medicine, St Thomas' Hospital, London, United Kingdom
| | - Eugene Oteng-Ntim
- Women's and Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Oakley LL, Awogbade M, Brien S, Briley A, Chorozoglou M, Drasar E, Johns J, Rhodes E, Robinson V, Seed P, Sharif J, Singh C, Telfer P, Thompson H, Watt-Coote I, Howard J, Oteng-Ntim E. Serial prophylactic exchange blood transfusion in pregnant women with sickle cell disease (TAPS-2): study protocol for a randomised controlled feasibility trial. Trials 2020; 21:347. [PMID: 32312326 PMCID: PMC7171865 DOI: 10.1186/s13063-020-4212-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pregnancies in women with sickle cell disease (SCD) are associated with a higher risk of sickle and pregnancy complications. Limited options exist for treating SCD during pregnancy. Serial prophylactic exchange blood transfusion (SPEBT) has been shown to be effective in treating SCD outside pregnancy, but evidence is lacking regarding its use during pregnancy. The aim of this study is to assess the feasibility and acceptability of conducting a future phase 3 randomised controlled trial (RCT) to establish the clinical and cost effectiveness of SPEBT in pregnant women with SCD. METHODS The study is an individually randomised, two-arm, feasibility trial with embedded qualitative and health economic studies. Fifty women, 18 years of age and older, with SCD and a singleton pregnancy at ≤ 18 weeks' gestation will be recruited from six hospitals in England. Randomisation will be conducted using a secure online database and minimised by centre, SCD genotype and maternal age. Women allocated to the intervention arm will receive SPEBT commencing at ≤ 18 weeks' gestation, performed using automated erythrocytapheresis every 6-10 weeks until the end of pregnancy, aiming to maintain HbS% or combined HbS/HbC% below 30%. Women in the standard care arm will only receive transfusion when clinically indicated. The primary outcome will be the recruitment rate. Additional endpoints include reasons for refusal to participate, attrition rate, protocol adherence, and maternal and neonatal outcomes. Women will be monitored throughout pregnancy to assess maternal, sickle, and foetal complications. Detailed information about adverse events (including hospital admission) and birth outcomes will be extracted from medical records and via interview at 6 weeks postpartum. An embedded qualitative study will consist of interviews with (a) 15-25 trial participants to assess experiences and acceptability, (b) 5-15 women who decline to participate to identify barriers to recruitment and (c) 15-20 clinical staff to explore fidelity and acceptability. A health economic study will inform a future cost effectiveness and cost-utility analysis. DISCUSSION This feasibility study aims to rigorously evaluate SPEBT as a treatment for SCD in pregnancy and its impact on maternal and infant outcomes. TRIAL REGISTRATION NIH registry (www.clinicaltrials.gov), registration number NCT03975894 (registered 05/06/19); ISRCTN (www.isrctn.com), registration number ISRCTN52684446 (retrospectively registered 02/08/19).
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Affiliation(s)
- Laura L Oakley
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, N-0213, Oslo, Norway.
| | - Moji Awogbade
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Sarah Brien
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Annette Briley
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, 5001, South Australia, Australia
| | - Maria Chorozoglou
- Southampton Health Technology Assessment Centre, Faculty of Medicine, University of Southampton, The University of Southampton Science Park, Alpha House, Enterprise Road, Southampton, SO17 1BJ, UK
| | - Emma Drasar
- Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Jemma Johns
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Elizabeth Rhodes
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Vicky Robinson
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Paul Seed
- Division of Women's Health, Kings College London, St Thomas' Hospital, 10th floor North Wing, Lambeth Palace Road, London, SE1 7EH, UK
| | - Joseph Sharif
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Claire Singh
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Paul Telfer
- Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK
| | - Hilary Thompson
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Ingrid Watt-Coote
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Jo Howard
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Haematological Medicine, King's College London, Rayne Institute, London, SE5 9NU, UK
| | - Eugene Oteng-Ntim
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Division of Women's Health, Kings College London, St Thomas' Hospital, 10th floor North Wing, Lambeth Palace Road, London, SE1 7EH, UK
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Kroll ME, Kurinczuk JJ, Hollowell J, Macfarlane A, Li Y, Quigley MA. Ethnic and socioeconomic variation in cause-specific preterm infant mortality by gestational age at birth: national cohort study. Arch Dis Child Fetal Neonatal Ed 2020; 105:56-63. [PMID: 31123058 PMCID: PMC6951229 DOI: 10.1136/archdischild-2018-316463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth. DESIGN National birth cohort study. SETTING England and Wales 2006-2012. SUBJECTS Singleton live births at 24-36 completed weeks' gestation (n=256 142). OUTCOME MEASURES Adjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24-27, 28-31, 32-36 weeks), by baby's ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles). RESULTS Among 24-27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32-36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions. CONCLUSIONS Gestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.
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Affiliation(s)
- Mary E Kroll
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer Hollowell
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison Macfarlane
- Department of Midwifery, School of Health Sciences, City University, London, UK
| | - Yangmei Li
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Smith-Whitley K. Complications in pregnant women with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:359-366. [PMID: 31808864 PMCID: PMC6913482 DOI: 10.1182/hematology.2019000039] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Pregnancy in women with sickle cell disease (SCD) is associated with increased maternal and fetal morbidity and mortality. Outcomes vary widely owing to methodological limitations of clinical studies, but overall, hypertensive disorders of pregnancy, venothromboembolism, poor fetal growth, and maternal and perinatal mortality are increased globally. Few therapeutic interventions have been explored other than prophylactic and selective transfusion therapy. Unfortunately, existing data are limited, and it remains unclear whether prophylactic use of chronic transfusions will improve pregnancy outcomes. Management of pregnant women with SCD is best accomplished with a multidisciplinary team that includes a sickle cell expert and an obstetrician familiar with high-risk pregnancies. Women with SCD should have individualized care plans that outline management of acute pain and guidelines for transfusion therapy. Neonates require close monitoring for neonatal abstinence syndrome and hemolytic disease of the newborn. Ideally all young women with SCD will have a "reproductive life plan" developed as a component of preconception counseling and health promotion. Research leading to improved pregnancy management focused on diminishing adverse maternal and neonatal outcomes is overdue. International collaborations should be considered to improve subject recruitment and foster timely completion of clinical trials. Additional therapeutic interventions outside of transfusion therapy should be explored.
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Affiliation(s)
- Kim Smith-Whitley
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
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38
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Asare EV, Olayemi E, Boafor T, Dei‐Adomakoh Y, Mensah Dip E, Benjamin CH, Covert B, Kassim AA, James A, Rodeghier M, DeBaun MR, Oppong SA. Third trimester and early postpartum period of pregnancy have the greatest risk for ACS in women with SCD. Am J Hematol 2019; 94:E328-E331. [PMID: 31571271 DOI: 10.1002/ajh.25643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Eugenia Vicky Asare
- Ghana Institute of Clinical Genetics Korle Bu Teaching Hospital Accra Ghana
- Department of Hematology Korle Bu Teaching Hospital Accra Ghana
| | - Edeghonghon Olayemi
- Ghana Institute of Clinical Genetics Korle Bu Teaching Hospital Accra Ghana
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Theodore Boafor
- Department of Obstetrics and Gynecology Korle Bu Teaching Hospital Accra Ghana
- Department of Obstetrics and Gynecology University of Ghana Medical School Accra Ghana
| | - Yvonne Dei‐Adomakoh
- Ghana Institute of Clinical Genetics Korle Bu Teaching Hospital Accra Ghana
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Enoch Mensah Dip
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Charles Hayfron Benjamin
- Department of Physiology University of Ghana Medical School Accra Ghana
- Department of Anesthesia Korle Bu Teaching Hospital Accra Ghana
| | - Brittany Covert
- Vanderbilt‐Meharry, Center of Excellence in Sickle Cell Disease Vanderbilt University Medical Center Nashville Tennessee
| | - Adetola A. Kassim
- Vanderbilt‐Meharry, Center of Excellence in Sickle Cell Disease Vanderbilt University Medical Center Nashville Tennessee
| | | | | | - Michael R. DeBaun
- Vanderbilt‐Meharry, Center of Excellence in Sickle Cell Disease Vanderbilt University Medical Center Nashville Tennessee
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology Korle Bu Teaching Hospital Accra Ghana
- Department of Obstetrics and Gynecology University of Ghana Medical School Accra Ghana
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39
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Baptista LC, Figueira CO, Souza BB, Fertrin KY, Antolini A, Costa FF, de Melo MB, Costa ML. Different morphological and gene expression profile in placentas of the same sickle cell anemia patient in pregnancies of opposite outcomes. Exp Biol Med (Maywood) 2019; 244:395-403. [PMID: 30818999 DOI: 10.1177/1535370219834305] [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: 11/15/2022] Open
Abstract
IMPACT STATEMENT Environmentally induced changes in placental morphological and molecular phenotypes may provide relevant insight towards pathophysiology of diseases. The rare opportunity to evaluate the same patient, with sickle cell anemia (SCA), in two different pregnancies, of opposite outcomes (one early onset severe preeclampsia (PE) and the other mostly non-complicated) can prove such concept. In addition, the comparison to other conditions of known placental and vascular/inflammatory involvement strengthens such findings. Our results suggest that the clinical association between SCA and PE can be supported by common pathophysiological mechanisms, but that pathways involving response to copper and triglyceride metabolism may be important drivers of the pathophysiology of PE. Future studies using in a larger number of samples should confirm these findings and explore pathways involved in the pathophysiology of PE and its relationship with SCA.
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Affiliation(s)
- Letícia C Baptista
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil.,*Shared first and last authorship
| | - Camilla O Figueira
- 2 Department of Obstetrics and Gynecology, University of Campinas - UNICAMP, Campinas, SP 13083-880, Brazil.,*Shared first and last authorship
| | - Bruno B Souza
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil
| | - Kleber Y Fertrin
- 3 Division of Hematology, University of Washington, Seattle, WA 98195-7230, USA
| | - Arthur Antolini
- 4 Department of Pathology, University of Campinas - UNICAMP, Campinas, SP 13083-887, Brazil
| | - Fernando F Costa
- 5 Hematology and Hemotherapy Center, University of Campinas - UNICAMP, Campinas, SP 13083-878
| | - Mônica B de Melo
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil.,*Shared first and last authorship
| | - Maria Laura Costa
- 2 Department of Obstetrics and Gynecology, University of Campinas - UNICAMP, Campinas, SP 13083-880, Brazil.,*Shared first and last authorship
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40
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Oppong SA, Asare EV, Olayemi E, Boafor T, Dei-Adomakoh Y, Swarry-Deen A, Mensah E, Osei-Bonsu Y, Crabbe S, Musah L, Hayfron-Benjamin C, Covert B, Kassim AA, James A, Rodeghier M, Audet C, DeBaun MR. Multidisciplinary care results in similar maternal and perinatal mortality rates for women with and without SCD in a low-resource setting. Am J Hematol 2019; 94:223-230. [PMID: 30456766 DOI: 10.1002/ajh.25356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 11/05/2022]
Abstract
In Africa, the maternal mortality rate in sickle cell disease (SCD) is ~10%. Our team previously demonstrated an 89% decrease in mortality rate in a before-and-after feasibility study among women with SCD living in low-resource setting in Ghana. In the same cohort including additional participants with and without SCD, we used a prospective cohort design to test the hypothesis that implementing a multidisciplinary care team for pregnant women with SCD in low-resource setting will result in similar maternal and perinatal mortality rates compared to women without SCD. We prospectively enrolled pregnant women with and without SCD or trait and followed them up for 6-week postpartum. We tested the newborns of mothers with SCD for SCD. We recruited age and parity matched pregnant women without SCD or trait as the comparison group. Maternal and perinatal mortality rates were the primary outcomes. A total of 149 pregnant women with SCD (HbSS, 54; HbSC, 95) and 117 pregnant women without SCD or trait were included in the analysis. Post-intervention, maternal mortality rates were 1.3% and 0.9% in women with and without SCD, respectively (P = 1.00); the perinatal mortality rates were 7.4% and 3.4% for women with and without SCD, respectively (P = 0.164). Among the mothers with SCD, ~15% of newborns had SCD. Multidisciplinary care of pregnant women with SCD may reduce maternal and perinatal mortality rates to similar levels in pregnant women without SCD in low-resource settings. Newborns of mothers with SCD have a high rate of SCD.
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Affiliation(s)
- Samuel A. Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry; University of Ghana; Accra Ghana
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Eugenia V. Asare
- Ghana Institute of Clinical Genetics; Accra Ghana
- Department of Hematology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Edeghonghon Olayemi
- Ghana Institute of Clinical Genetics; Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Theodore Boafor
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry; University of Ghana; Accra Ghana
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Yvonne Dei-Adomakoh
- Ghana Institute of Clinical Genetics; Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Alim Swarry-Deen
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Enoch Mensah
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | | | | | - Latif Musah
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
- Department of Anesthesia; Korle-Bu Teaching Hospital; Accra Ghana
| | - Brittany Covert
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease; Vanderbilt University Medical Center; Nashville Tennessee
| | - Adetola A. Kassim
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease; Vanderbilt University Medical Center; Nashville Tennessee
| | - Andra James
- Department of Obstetrics and Gynaecology; Duke University; Durham North Carolina
| | | | - Carolyn Audet
- Global Health Institute; Vanderbilt University Medical Center; Nashville Tennessee
| | - Michael R. DeBaun
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease; Vanderbilt University Medical Center; Nashville Tennessee
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Cardosa D, Ridout A, Nanda S, Howard J, Robinson SE, Oteng-Ntim E. Maternal sickle cell disease and twin pregnancy: a case series and review of the literature. Hematology 2018; 24:148-158. [DOI: 10.1080/10245332.2018.1535534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Deyna Cardosa
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Alexandra Ridout
- Women’s Health, St Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Surabhi Nanda
- Liverpool Women’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Jo Howard
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Susan E. Robinson
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Women’s Health, St. Thomas’ Hospital, King's Health Partners, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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42
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Silva FAC, Ferreira ALCG, Hazin-Costa MF, Dias MLG, Araújo AS, Souza AI. Adverse clinical and obstetric outcomes among pregnant women with different sickle cell disease genotypes. Int J Gynaecol Obstet 2018; 143:89-93. [PMID: 30030929 DOI: 10.1002/ijgo.12626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/15/2018] [Accepted: 07/20/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare clinical and obstetric adverse events among pregnant women with sickle cell disease (SCD) according to genotype. METHODS The present cross-sectional study enrolled women aged 15-49 years with SCD and prior pregnancy attending a hematology center in Recife, Brazil, between September 1, 2015, and April 30, 2016. Associations between sickle cell genotype (HbSS, HbSC, Sβ-thalassemia) and adverse events were evaluated. RESULTS Overall, 89 women were included; 74 (83%) had HbSS genotype, 8 (9%) had HbSC genotype, and 7 (8%) had Sβ-thalassemia genotype. Fifty-three (60%) self-reported being of mixed race, and 27 (30%) self-reported they were black. Blood transfusion was observed more frequently among women with HbSS than among those with HbSC genotype (P=0.007). Postpartum adverse events were more frequent in the Sβ-thalassemia than in the HbSS group (P=0.030). Fetal intrauterine death occurred only among women with the HbSS genotype (11 [15%]). In the HbSS group, there was a higher frequency of blood transfusion (P=0.004) and lower rate of spontaneous abortion (P=0.001) among women with six or more consultations. CONCLUSION The HbSS genotype was associated with a higher frequency of blood transfusion. Sβ-thalassemia was associated with a higher frequency of postpartum adverse events. Prenatal care was associated with a lower rate of spontaneous abortion in the HbSS group.
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Affiliation(s)
- Flávia A C Silva
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.,Faculdade Pernambucana de Saúde, Recife, Brazil
| | | | - Manuela F Hazin-Costa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.,Hematology Department at Universidade Federal de Pernambuco, Recife, Brazil.,Fundação de Hematologia e Hemoterapia de Pernambuco, Recife, Brazil
| | | | - Aderson S Araújo
- Fundação de Hematologia e Hemoterapia de Pernambuco, Recife, Brazil
| | - Ariani I Souza
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.,Faculdade Pernambucana de Saúde, Recife, Brazil
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Biller E, Zhao Y, Berg M, Boggio L, Capocelli KE, Fang DC, Koepsell S, Music-Aplenc L, Pham HP, Treml A, Weiss J, Wool G, Baron BW. Red blood cell exchange in patients with sickle cell disease-indications and management: a review and consensus report by the therapeutic apheresis subsection of the AABB. Transfusion 2018; 58:1965-1972. [PMID: 30198607 DOI: 10.1111/trf.14806] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND A prior practice survey revealed variations in the management of patients with sickle cell disease (SCD) and stressed the need for comprehensive guidelines. Here we discuss: 1) common indications for red blood cell exchange (RCE), 2) options for access, 3) how to prepare the red blood cells (RBCs) to be used for RCE, 4) target hemoglobin (Hb) and/or hematocrit (Hct) and HbS level, 5) RBC depletion/RCE, and 6) some complications that may ensue. STUDY DESIGN AND METHODS Fifteen physicians actively practicing apheresis from 14 institutions representing different areas within the United States discussed how they manage RCE for patients with SCD. RESULTS Simple transfusion is recommended to treat symptomatic anemia with Hb level of less than 9 g/dL. RCE is indicated to prevent or treat complications arising from the presence of HbS. The most important goals are reduction of HbS while also preventing hyperviscosity. The usual goals are a target HbS level of not more than 30% and Hct level of less than 30%. CONCLUSION Although a consensus as to protocol details may not be possible, there are areas of agreement in the management of these patients, for example, that it is optimal to avoid hyperviscosity and iron overload, that a target Hb S level in the range of 30% is generally desirable, and that RCE as an acute treatment for pain crisis in the absence of other acute or chronic conditions is ordinarily discouraged.
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Affiliation(s)
- Elizabeth Biller
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yong Zhao
- Departments of Medicine and Pathology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mary Berg
- Department of Pathology, University of Colorado Hospital, Aurora, Colorado
| | - Lisa Boggio
- Rush University Medical Center, Chicago, Illinois
| | - Kelley E Capocelli
- Department of Pathology, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Deanna C Fang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
| | - Scott Koepsell
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Huy P Pham
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Angela Treml
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - John Weiss
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Geoffrey Wool
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Beverly W Baron
- Department of Pathology, University of Chicago, Chicago, Illinois
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Vianello A, Vencato E, Cantini M, Zanconato G, Manfrin E, Zamo A, Zorzi F, Mazzi F, Martinelli N, Cavaliere E, Monari F, Venturelli D, Ferrara F, Olivieri O, De Franceschi L. Improvement of maternal and fetal outcomes in women with sickle cell disease treated with early prophylactic erythrocytapheresis. Transfusion 2018; 58:2192-2201. [PMID: 29984534 DOI: 10.1111/trf.14767] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/26/2018] [Accepted: 03/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The desire for pregnancy in sickle cell disease (SCD) women has become a true challenge for hematologists, requiring a multidisciplinary approach. Erythrocytapheresis (ECP) is an important therapeutic tool in SCD, but only limited data on starting time and the effects of ECP during pregnancy are available. STUDY DESIGN AND METHODS This is a double-center retrospective cross-sectional study on a total of 46 single pregnancies in SCD women from January 2008 to June 2017. ECP was started at 10.7 ± 5.2 weeks of gestation, and prophylactic enoxaparin (4,000 U daily) was introduced due to the reported high prevalence of thromboembolic events in pregnant SCD women. RESULTS The alloimmunization ratio was 2.1 per 1,000 and the alloimmunization rate was 5.6%. In early ECP-treated SCD women, no severe vaso-occlusive crisis, sepsis or severe infection, or preeclampsia or eclampsia were observed. We found normal umbilical arterial impedance during pregnancy, suggesting an optimal uteroplacental function in early ECP-treated SCD women. This was also supported by the improvement in newborn birthweights compared to previous studies. In our cohort, three SCD women were started later on ECP (20-25 weeks), and gestation ended with late fetal loss. Placenta pathology documented SCD-related damage and erythroblasts in placental vessels, indicating fetal hypoxia. CONCLUSIONS Collectively, our data generate a rationale to support a larger clinical trial of early ECP program in SCD pregnancy.
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Affiliation(s)
- Alice Vianello
- Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
| | - Elisa Vencato
- Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
| | | | - Giovanni Zanconato
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona and AOUI-Verona, Mother and Child Hospital, Verona, Italy
| | - Erminia Manfrin
- Department of Diagnostic and Public Health, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
| | - Alberto Zamo
- Department of Diagnostic and Public Health, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
| | - Francesco Zorzi
- Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
| | - Filippo Mazzi
- Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
| | - Nicola Martinelli
- Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
| | - Elena Cavaliere
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona and AOUI-Verona, Mother and Child Hospital, Verona, Italy
| | | | - Donatella Venturelli
- Department of Transfusion Medicine, Azienda Ospedaliera Universitaria-Modena, University of Modena, Modena, Italy
| | - Francesca Ferrara
- Department of Mother and Child, Azienda Ospedaliera Universitaria-Modena, University of Modena, Modena, Italy
| | - Oliviero Olivieri
- Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
| | - Lucia De Franceschi
- Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
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45
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Current Evidence for the Use of Prophylactic Transfusion to Treat Sickle Cell Disease During Pregnancy. Transfus Med Rev 2018; 32:220-224. [PMID: 30029813 DOI: 10.1016/j.tmrv.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/25/2018] [Accepted: 06/02/2018] [Indexed: 11/22/2022]
Abstract
The role of prophylactic transfusion therapy for the treatment of sickle cell disease during pregnancy is unclear. An analysis of the existing literature shows a limited number of publications that address this issue and specifically compare clinical outcomes in this population based on a treatment strategy of prophylactic transfusion versus transfusion only for clinical indications (on-demand transfusion). The existing studies show a wide variation in study design and outcomes measured. The results of this analysis suggest that there are insufficient data to support a clinically significant difference in morbidity and mortality outcomes based on transfusion strategy. Additional prospective clinical studies need to be performed to adequately address the risks and benefits of prophylactic transfusion and guide clinical decision making.
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46
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Obilade OA, Akanmu AS, Broughton Pipkin F, Afolabi BB. Prostacyclin, thromboxane and glomerular filtration rate are abnormal in sickle cell pregnancy. PLoS One 2017; 12:e0184345. [PMID: 28880908 PMCID: PMC5589233 DOI: 10.1371/journal.pone.0184345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/22/2017] [Indexed: 11/17/2022] Open
Abstract
Background Pregnancy increases the risk of morbidity and mortality in sickle cell disease. We previously showed pregnant women with sickle cell disease to have a relatively low plasma renin concentration in late pregnancy, associated with a lack of the expected plasma volume expansion. We hypothesized this to be due to increased systemic vascular resistance through an imbalance between the vasodilator prostacyclin and vasoconstrictor thromboxane, associated with decreased glomerular filtration rate (GFR). Objective To compare estimated prostacyclin, thromboxane and GFR in non-pregnant and pregnant women with hemoglobin SS (HbSS) and AA (HbAA). Study design Four groups of 20 normotensive, nulliparous women were studied in Lagos, Nigeria: pregnant HbSS or HbAA women at 36–40 weeks gestation; non-pregnant HbSS and HbAA controls. We measured stable metabolites of prostacyclin and thromboxane A2 by enzyme-linked immunosorbent assay; GFR using the Cockcroft-Gault equation. Data analysis was by independent (Student’s) t-test or Mann-Whitney U test for comparisons between any two groups of continuous variables, univariate ANOVA for multiple groups and Pearson’s correlation coefficient for degree of association between variables. Results HbSS women had lower serum 6-keto-PGF1α concentrations than HbAA, whether pregnant or non-pregnant (P<0.001; P<0.004 respectively). Conversely, pregnant HbSS women had higher serum TxB2 (P<0.001); non-pregnant HbSS women had non-significantly higher TxB2 concentrations. The 6-keto-PGF1α:TxB2 ratio was markedly increased (pro-vasodilatory) in HbAA pregnancy (P<0.001) but reduced in HbSS pregnancy (P = 0.037). GFRs (mL/min) were higher in non-pregnant HbSS than HbAA (P<0.008) but only marginally raised in HbSS women in late pregnancy (P = 0.019) while markedly raised in HbAA pregnancy (P<0.001). Conclusion The lower ratio of prostacyclin-thromboxane metabolites in HbSS pregnancy may indicate endothelial damage and an increased tendency to vasoconstriction and clotting. If confirmed by subsequent longitudinal studies, interventions to increase prostacyclin and reduce thromboxane, such as low dose aspirin, may be potentially useful in their management.
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Affiliation(s)
- Opeyemi Abayomi Obilade
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, State House Medical Centre, Aso Rock, Asokoro, Abuja, Nigeria
| | - Alani Suleimon Akanmu
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.,Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Fiona Broughton Pipkin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
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47
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Asare EV, Olayemi E, Boafor T, Dei-Adomakoh Y, Mensah E, Ghansah H, Osei-Bonsu Y, Crabbe S, Musah L, Hayfron-Benjamin C, Covert B, Kassim AA, James A, Rodeghier M, DeBaun MR, Oppong SA. Implementation of multidisciplinary care reduces maternal mortality in women with sickle cell disease living in low-resource setting. Am J Hematol 2017; 92:872-878. [PMID: 28512745 DOI: 10.1002/ajh.24790] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/12/2022]
Abstract
Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low-resource settings, pregnancy is associated with significantly increased maternal and perinatal mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low-resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before-and-after study, at the Korle-Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric-hematology care team for women with SCD in a combined SCD-Obstetric Clinic. The pre-intervention period was assessed through a retrospective chart review to identify every death and the post-intervention period was assessed prospectively. Interventions consisted of joint obstetrician and hematologist outpatient and acute inpatient reviews, close maternal and fetal surveillance, and simple protocols for management of acute chest syndrome and acute pain episodes. Primary outcomes included maternal and perinatal mortality rates before and after the study period. A total of 158 and 90 pregnant women with SCD were evaluated in the pre- and post- intervention periods, respectively. The maternal mortality rate decreased from 10 791 per 100 000 live births at pre-intervention to 1176 per 100 000 at post-intervention, representing a risk reduction of 89.1% (P = 0.007). Perinatal mortality decreased from 60.8 per 1000 total births at pre-intervention to 23.0 per 1000 at post-intervention, representing a risk reduction of 62.2% (P = 0.20). A multidisciplinary obstetric and hematology team approach can dramatically reduce maternal and perinatal mortality in a low-resource setting.
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Affiliation(s)
- Eugenia Vicky Asare
- Ghana Institute of Clinical Genetics; Korle-Bu Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Edeghonghon Olayemi
- Ghana Institute of Clinical Genetics; Korle-Bu Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Theodore Boafor
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Yvonne Dei-Adomakoh
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Enoch Mensah
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Harriet Ghansah
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | | | - Selina Crabbe
- Ghana Institute of Clinical Genetics; Korle-Bu Accra Ghana
| | - Latif Musah
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
- Department of Anesthesia; Korle-Bu Teaching Hospital; Accra Ghana
| | - Brittany Covert
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Adetola A. Kassim
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | | | | | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry; University of Ghana; Accra Ghana
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48
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Faye BF, Kouame KB, Seck M, Diouf AA, Gadji M, Dieng N, Touré SA, Sall A, Toure AO, Diop S. Challenges in the management of sickle cell disease during pregnancy in Senegal, West Africa. Hematology 2017; 23:61-64. [DOI: 10.1080/10245332.2017.1367534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Blaise Felix Faye
- Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | | | - Moussa Seck
- Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Abdou Aziz Diouf
- Gynecology and Obstetrics, Cheikh Anta Diop University, Dakar, Senegal
| | - Macoura Gadji
- Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Nata Dieng
- Hematology, Cheikh Anta Diop University, Dakar, Senegal
| | | | - Abibatou Sall
- Hematology, Cheikh Anta Diop University, Dakar, Senegal
| | | | - Saliou Diop
- Hematology, Cheikh Anta Diop University, Dakar, Senegal
- Centre National de Transfusion Sanguine, Dakar, Senegal
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49
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Sharif J, Byrd L, Stevenson K, Raddats J, Morsman E, Ryan K. Transfusion for sickle cell disease in pregnancy: a single-centre survey. Transfus Med 2017; 28:231-235. [DOI: 10.1111/tme.12447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/16/2017] [Accepted: 06/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J. Sharif
- Department of Haematology; Manchester Royal Infirmary; Manchester UK
| | - L. Byrd
- Department of Obstetrics; St Mary's Hospital; Manchester UK
| | - K. Stevenson
- Department of Haematology; Manchester Royal Infirmary; Manchester UK
| | - J. Raddats
- Department of Haematology; Manchester Royal Infirmary; Manchester UK
| | - E. Morsman
- Department of Obstetrics; St Mary's Hospital; Manchester UK
| | - K. Ryan
- Department of Haematology; Manchester Royal Infirmary; Manchester UK
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50
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Macedo FB, Júnior JG, Guimarães FG, Tomaz RC, Monte Alto DV, Pinheiro PP, Coelho JMN. SC Hemoglobinopathy (HbSC) with Osteoarticular Complications: Case Report. Health (London) 2017. [DOI: 10.4236/health.2017.97078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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