Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 11 , ISSUE 6 ( November-December, 2019 ) > List of Articles

Original Article

A Prospective Study to Compare the Maternal and Fetal Outcomes among Sickle Cell Disease and Trait Women

Santosh Kumar Dora, Atal B Dandapat, Benudhar Pande, Ganeshram Bhoi, Bhawana Tiwari

Keywords : Sickle cell anemia, Sickle cell crisis, Sickle cell disease, Sickle cell trait

Citation Information : Dora SK, Dandapat AB, Pande B, Bhoi G, Tiwari B. A Prospective Study to Compare the Maternal and Fetal Outcomes among Sickle Cell Disease and Trait Women. J South Asian Feder Obs Gynae 2019; 11 (6):340-344.

DOI: 10.5005/jp-journals-10006-1724

License: CC BY-NC 4.0

Published Online: 25-12-2012

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Introduction: We conducted a prospective trial to compare the maternal and fetal outcomes between the sickle cell disease (SCD) and sickle cell trait (SCT) pregnant patients. Materials and methods: From December 2015 to December 2016, a total of 59 patients were diagnosed with SCD and 119 patients with SCT. All the fetal and maternal parameters were compared between them. Results: A total of 17 (28.8%) SCD and 5 (4.2%) SCT patients presented with painful crisis. Acute chest syndrome developed in 9 (15.3%) of SCD and 1 (0.8%) of SCT cases. Hemolytic crisis was seen in 4 (6.8%) of SCD patients. The incidence of hypertension, preeclampsia, jaundice, blood transfusion during pregnancy, and IUGR among the SCD and SCT patients were 11 (18.6%) vs 5 (4.2%) (p = 0.000), 19 (32.2%) vs 7 (5.9%) (p = 0.000), 15 (25.4%) vs 0 (0%) (p = 0.000), 36 (61%) vs 8 (6.7%) (p = 0.000), and 33 (55.9%) vs 21 (17.6%) (p = 0.000), respectively. The mean periods of gestation of delivery were significantly lower, i.e., 36.5 ± 2.76 weeks for SCD patients compared to 38.2 ± 2.1 weeks for SCT patients (p = 0.000). Ten (16.9%) of SCD and one (0.8%) of SCT patients had intrauterine death. Average birth weights of babies delivered were 2142 ± 557.45 g and 2684 ± 551.23 g for SCD and SCT patients, respectively. Conclusion: Sickle cell anemia causes an increased risk to both mother and fetus. Sickle cell disease women are more prone to develop sickle cell crisis as well as increased obstetrical complication. A preconceptional counseling of all sickling women with a multidisciplinary approach can prevent many of the maternal and fetal complications during pregnancy.


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  1. Stuart MJ, Nagel RL. Sickle cell disease. Lancet 2004;364:1343–1360. DOI: 10.1016/S0140-6736(04)17192-4.
  2. Serjeant GR. The emerging understanding of sickle cell disease. Br J Haematol 2001;112(1):3–18. DOI: 10.1046/j.1365-2141.2001.02557.x.
  3. Piel FB, Patil AP, Howes RE, et al. Global epidemiology of sickle haemoglobin in neonates: a contemporary geostatistical modelbased map and population estimates. Lancet 2013;381(9861):142–151. DOI: 10.1016/S0140-6736(12)61229-X.
  4. Claster S, Vichinsky EP. Managing sickle cell disease. BMJ 2003;327:1151–1155. DOI: 10.1136/bmj.327.7424.1151.
  5. Serjeant GR, Hambleton I, Thame M. Fecundity and pregnancy outcome in a cohort with sickle cell-haemoglobin C disease followed from birth. BJOG 2005;112(9):1308–1314. DOI: 10.1111/j.1471- 0528.2005.00678.x.
  6. Larrabee KD, Monga M. Women with sickle cell trait are at increased risk for preeclampsia. Am J Obstet Gynecol 1997;177(2):425. DOI: 10.1016/S0002-9378(97)70209-6.
  7. Serjeant GR, Loy LL, Crowther M, et al. Outcome of pregnancy in homozygous sickle cell disease. Obstet Gynecol 2004;103(6): 1278–1285. DOI: 10.1097/01.AOG.0000127433.23611.54.
  8. Villers MS, Jamison MG, De Castro LM, et al. Morbidity associated with sickle cell disease in pregnancy. Am J Obstet Gynecol 2008;199(2):125. e1–125.e5. DOI: 10.1016/j.ajog.2008.04.016.
  9. Chakravarty EF, Khanna D, Chung L. Pregnancy outcomes in systemic sclerosis, primary pulmonary hypertension, and sickle cell disease. Obstet Gynecol 2008;111(4):927–934. DOI: 10.1097/01. AOG.0000308710.86880.a6.
  10. Al Jama FE, Gasem T, Burshaid S, et al. Pregnancy outcome in patients with homozygous sickle cell disease in a university hospital, Eastern Saudi Arabia. Arch Gynecol Obstet 2009;280(5):793–797. DOI: 10.1007/ s00404-009-1002-7.
  11. Zia S, Rafique M. Comparison of pregnancy outcomes in women with sickle cell disease and trait. J Pak Med Assoc 2013;63(6):743–746.
  12. Roberts JM, Myatt L, Spong CY, et al. Vitamins C and E to prevent complications of pregnancy-associated hypertension. N Engl J Med 2010;362(14):1282. DOI: 10.1056/NEJMoa0908056.
  13. Royal College of Obstetricians and Gynecologists. Management of Sickle Cell Disease in Pregnancy. Royal College of Obstetricians and Gynecologists Green–top Guideline No. 61. July; 2011.
  14. Oteng-Ntim E, Ayensah B, Knight M, et al. Pregnancy outcome inpatients with sickle cell disease in the UK— a national cohort study comparing sickle cell anemia (HbSS) with HbSC disease. Br J Haematol 2015;169(1):129–137. DOI: 10.1111/bjh.13270.
  15. Oteng-Ntim E, Meeks D, Seed PT, et al. Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis. Blood 2015;125(21):3316–3325. DOI: 10.1182/blood-2014-11-607317.
  16. Malinowski AK, Shehata N, D’Souza R, et al. Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis. Blood 2015;126(21):2424–2435.
  17. Ngo C, Kayem G, Habibi A, et al. Pregnancy in sickle cell disease: maternal and fetal outcomes in a population receiving prophylactic partial exchange transfusions. Eur J ObstetGynecol Reprod Biol 2010;152(2):138–142. DOI: 10.1016/j.ejogrb.2010.05.022.
  18. Asma S, Kozanoglu I, Tarým E, et al. Prophylacticred cell exchange may be beneficial in the management of sickle cell disease in pregnancy. Transfusion (Paris) 2014;55(1):36–44. DOI: 10.1111/trf.12780.
  19. Daigavane MM, Jena RK, Kar TJ. Perinatal outcome in sickle cell anemia: a prospective study from India. Hemoglobin 2013;37(6): 507–515. DOI: 10.3109/03630269.2013.828301.
  20. Resende Cardoso PS, Lopes Pessoa de Aquiar RA, Vianaa MB. Clinical complications in pregnant women with sickle cell disease: prospective study of factors predicting maternal death or near miss. Rev Bras Hematol Hemoter 2014;36(4):256–263. DOI: 10.1016/ j.bjhh.2014.05.007.
  21. Al Kahtani MA, AlQahtani M, Alshebaily MM, et al. Morbidity and pregnancy outcomes associated with sickle cell anemia among Saudi women. Int J Gynaecol Obstet 2012;119:224–226. DOI: 10.1016/ j.ijgo.2012.07.008.
  22. Alayed N, Kezouh A, Oddy L, et al. Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births. J PerinatMed 2013;17:1–6.
  23. Stein P, Hull R, Jayali F, et al. Venous thromboembolism in pregnancy: 21-year trends. Am J Med 2004;117(2):121–125. DOI: 10.1016/ j.amjmed.2004.02.021.
  24. Sultan AA, Tata LJ, Grainge MJ, et al. The incidence of first venous thromboembolism in and around pregnancy Using Linked Primary and secondary care data: a population based cohort study from England and comparative meta-analysis. PLoS ONE 2013;8(7):e70310. DOI: 10.1371/journal.pone.0070310.
  25. Muganyizi PS, Kidanto H. Sickle cell disease in pregnancy: trend and pregnancy outcomes at a tertiary hospital in Tanzania. PLoS ONE 2013;8(2):e56541. DOI: 10.1371/journal.pone.0056541.
  26. Boga Can, Baskent HO. Pregnancy and sickle cell disease: a review of the current literature. Crit Rev Oncol Hematol 2016;98:364–374. DOI: 10.1016/j.critrevonc.2015.11.018.
  27. Howard J, Oteng-Ntim E. The obstetric management of sickle cell disease. Best Pract Res Clin Obstet Gynaecol 2012;26(1):25–36. DOI: 10.1016/j.bpobgyn.2011.10.001.
  28. Boulet SL, Okoroh EM, Azonobi I, et al. Sickle cell disease in pregnancy: maternal complications in a Medicaid-enrolled population. Matern. Child Health J 2013;17(2):200–207. DOI: 10.1007/s10995-012-1216-3.
  29. Al-Farsi SH, Al-Khabori MK, Al-Hunieni MN, et al. Fetal outcomes in pregnant women with sickle cell disease. Saudi Med J 2014;35(5): 472–476.
  30. Natu N, Khandelwal S, Kumar R, et al. Maternal and perinatal outcome of women with sickle cell disease of a tribal population in Central India. Hemoglobin 2014;38(2):91–94. DOI: 10.3109/03630269.2013. 869501.
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