Birth Weights in Sickle Cell Disease Pregnancies: A Cohort Study

Abstract

Pregnancy in women with Sickle Cell Disease (SCD) has been linked with an increased incidence of adverse foetal outcomes when compared to women without haemoglobinopathies (HbAA). There’s a paucity of data into foetal outcomes for infants born to women with SCD. Customised growth charts have been demonstrated to be better than population-based growth charts at identifying unhealthy small babies. We analysed the mean birth weight and customised birth weight centiles of infants born to mothers with SCD versus mothers with HbAA genotype, to quantify the risk of having a smaller baby. Birth weight and birth weight centiles were analysed for 88 women with SCD (50 HbSS; 38 HbSC) and 176 controls (HbAA). Statistically significant differences were seen in the mean birth weight (P value = 0.004) and the mean birth weight centiles (P value = 0.016). We conclude that SCD is a risk factor for having a smaller baby.

Improvement of maternal and fetal outcomes in women with sickle cell disease treated with early prophylactic erythrocytapheresis

“…In pregnancies complicated by intrapartum fetal distress, requiring emergency Cesarean section, high erythroblast counts have been reported and the magnitude of erythroblastosis is generally associated with the degree of fetal acidemia . In these three SCD subjects, we thought that placenta insufficiency related to local, recurrent vasoocclusive events might sustain a general fetal hypoxia, which contributes to poor fetal outcomes . Since this is a retrospective study, we have no histopathologic data on placentas from early ECP–treated SCD women.…”

“…However, the monthly evaluation of umbilical arterial Doppler did not reveal significant changes in umbilical arterial impedance, suggesting a normal uteroplacental function in SCD women under an early ECP program. This is also supported by the improvement in newborn birthweights from our cohort compared to those of other studies . In our cohort, the positive relation between LDH or Hb levels and the newborn weights further supports the importance of early reduction of HbS levels to avoid fetal hypoxia, allowing optimal fetal growth.…”

“…In this double‐center retrospective cross‐sectional study, we show that early ECP treatment ameliorates maternal and fetal outcomes in SCD women with a history of severe SCD‐related organ complications. In our cohort, ECP was started at 10.7 ± 5.2 weeks of gestation, which is earlier than that reported in other studies on either ECP or simple transfusion in SCD pregnant women . Importantly, ECP strategy was chosen based on 1) previous studies on ECP in pregnancy and 2) the effectiveness of ECP in rapidly reducing HbS levels and in preventing iron overload compared to simple direct transfusion …”

“…Previous studies have shown a poor outcome for pregnancy in SCD women with high maternal and fetal mortality and morbidity . Three main groups of complications have been identified: 1) the severe clinical manifestations related to SCD (i.e., recurrent acute vasoocclusive crisis [VOC], acute chest syndrome); 2) the medical complication of pregnancy (i.e., urinary infection, pyelonephritis); and 3) the obstetric complications (preeclampsia, intrauterine growth retardation [IUGR]) .…”

Evaluation of Umbilical Artery Doppler Indices in Pregnant Women With Sickle Cell Anemia Disease at a Nigerian Tertiary Hospital

“…where n = sample size of each group, u = one-sided percentage point of the normal distribution corresponding to 100% power (the power of this study was 90%), v = percentage point of the normal distribution corresponding to a two-sided significance level, u1 = expected mean (hypothetic mean): mean birthweight in healthy newborns is 3.0 kg, 36 and u0 = universal mean = mean birth weight seen in the literature in sickle cell pregnancies. 37 Universal mean (u0) from the literature 38 This was rounded down to 60. A control group of 60 HbAA pregnant women was also consecutively recruited following informed consent, giving a total of 120 participants.…”