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Early ML, Raja M, Luo A, Solow M, Matusiak K, Eke AC, Shehata N, Kuo KH, Lanzkron S, Malinowski AK, Pecker LH. Blood pressure thresholds for the diagnosis of hypertensive disorders of pregnancy in sickle cell disease. Br J Haematol 2024; 204:1039-1046. [PMID: 38093478 PMCID: PMC10939908 DOI: 10.1111/bjh.19248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024]
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 the characteristics of subjects with new or worsening proteinuria (NWP) during pregnancy to those without. We then constructed receiver operating characteristic (ROC) curves to determine the blood pressure (BP) that best identifies those with NWP. The SBP or DBP thresholds which maximized sensitivity and specificity were 120 mmHg SBP (sensitivity: 55.2%, specificity: 73.5%) and 70 mmHg DBP (sensitivity: 27.6%, specificity: 67.7%). The existing BP threshold of 140/90 mmHg lacked sensitivity in both genotype groups (HbSS/HbSβ0 : SBP = 21% sensitive, DBP = 5.3% sensitive; HbSS/HbSβ+ : SBP = 10% sensitive, DBP = 0% sensitive). Finally, percent change in SBP, DBP and MAP were all poor tests for identifying NWP. Existing BP thresholds used to diagnose hypertensive disorders of pregnancy (HDP) are not sensitive for pregnant people with SCD. For this population, lowering the BP threshold that defines HDP may improve identification of those who need increased observation, consideration of early delivery and eclampsia prophylaxis.
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Affiliation(s)
- Macy L. Early
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maidah Raja
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Luo
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 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
| | - 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 Hematology, Sinai Health System, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- 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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Othman M, Nemeti G, Solow M, Cruciat G, Muresan D, Chaikh Sulaiman MS, Thaker S, Abdul-Kadir R, Malinowski AK. Hematologic characteristics and coagulopathy in pregnancy with COVID-19 succeeding the first wave: a multicenter retrospective cross-sectional study. Res Pract Thromb Haemost 2024; 8:102339. [PMID: 38426027 PMCID: PMC10901829 DOI: 10.1016/j.rpth.2024.102339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/23/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background Early reports have demonstrated an association of COVID-19 infection during pregnancy and postpartum period with coagulopathy and bleeding complications and indicated that pregnant people with COVID-19 are more likely to experience coagulopathy and venous thromboembolism. A recent report concerning such complications during the first wave of the pandemic was reassuring; however, no publications have evaluated these issues in the context of increased illness severity with the emergence of SARS-CoV-2 variants of concern. Objectives We performed a retrospective, multinational cohort study in Canada, Romania, and the United Kingdom, aiming to provide a comprehensive analysis of the hematologic test characteristics of pregnancies affected by COVID-19 after the first wave of the pandemic. Results Three-hundred-seventy patients were evaluated. Markers of inflammation and endothelial dysfunction were significantly elevated, in keeping with observations in the nonpregnant population. Reassuringly, despite more severe disease noted in succeeding waves of the pandemic, there was no significant evidence of COVID-19-associated coagulopathy, and overall, no association was demonstrated between isolated coagulation abnormalities and bleeding risk. Notably, fibrinogen below 2g/L was again linked with the risk of postpartum hemorrhage. Finally, venous thromboembolism risk was low but noted more frequently in those with severe illness despite thromboprophylaxis. Conclusion Our findings add valuable insights into the nature of hematologic test characteristics, bleeding, and thrombotic complications for those affected with COVID-19 in pregnancy, reassuring readers of the low incidence of bleeding and thrombotic complications but inviting further debate as to the degree of thromboprophylaxis that may benefit the subgroup with severe disease.
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Affiliation(s)
- Maha Othman
- Department of Biomedical and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
- School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Georgiana Nemeti
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy of Cluj-Napoca, Cluj-Napoca, Romania
- Obstetrics and Gynecology I, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Marissa Solow
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Gheorghe Cruciat
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy of Cluj-Napoca, Cluj-Napoca, Romania
- Obstetrics and Gynecology I, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Daniel Muresan
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy of Cluj-Napoca, Cluj-Napoca, Romania
- Obstetrics and Gynecology I, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | | | - Shivani Thaker
- School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada
| | - Rezan Abdul-Kadir
- Department of Obstetrics and Gynaecology, The Royal Free National Health Service Foundation Hospital, London, United Kingdom
- Institute for Women’s Health, University College London, London, United Kingdom
| | - A. Kinga Malinowski
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
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Kroeker J, Keith J, Carruthers H, Hanna C, Qureshi N, Calic M, Kaye M, Solow M, Coey J, Sulaiman S. Investigating the time‐lapsed effects of rigid cervical collars on the dimensions of the internal jugular vein. Clin Anat 2019; 32:196-200. [DOI: 10.1002/ca.23264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 07/27/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jenna Kroeker
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
| | - Jay Keith
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
| | - Hailey Carruthers
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
| | - Cherry Hanna
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
| | - Natasha Qureshi
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
| | - Masa Calic
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
| | - Meagan Kaye
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
| | - Marissa Solow
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
| | - James Coey
- Keith B. Taylor Global Scholars Program at Northumbria UniversitySt. George's International School of Medicine Newcastle‐upon‐Tyne NE1 8ST UK
- Department of AnatomySt. George's University Grenada West Indies
| | - Sara Sulaiman
- Department of Applied SciencesNorthumbria University Newcastle‐upon‐Tyne NE1 8ST UK
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