Maternal/Perinatal Outcome in Women with Sickle Cell Disease: A Comparison of Two Time Periods.

OBJECTIVE: To compare pregnancy outcomes in women with sickle cell disease from recent deliveries with a similar group delivered earlier.

METHODS: During a 12-year period (2005-2016), data from pregnant women with hemoglobin SS or SC were collected from three university medical centers and compared with earlier studies (1979-2003) involving similar patients. The primary endpoints were maternal complications during pregnancy and newborn outcomes.

RESULTS: There were 278 patients in the control group (1979-2003) compared with 150 patients in the study group (2005-2016). Women in the study group were older ( P < 0.0001) and of less parity ( P =0.0001), and complications of preterm delivery, preeclampsia, and having a transfusion were similar between the two groups ( P = 0.45, 0.95, and 0.49, respectively). Pain crises were more common in the study group ( P = 0.02) as was cesarean section ( P < 0.0001), but there was a reduction in pulmonary complications ( P = 0.0002). Maternal mortality was uncommon (control group [N=4] vs study group [N=3], P = 0.40). Newborn statistics revealed a similar gestational age at delivery (37 weeks), and the incidence of intrauterine growth restriction, as well as 5-minute Apgar score <7 did not differ by group ( P = 0. 91, 0.85, and 0.16, respectively). Infants in the study group were heavier on average by approximately 220 g ( P = 0.02), whereas the neonatal death rate was low (control group [N=1], study group [N=2] P = 0.60).

CONCLUSIONS: Recent pregnancy outcome statistics in women with sickle cell disease have not changed through the years. Innovative strategies to improve maternal and newborn outcomes among such patients are needed.