Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998–2017)

Abstract

Summary 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.

Case Report: Obstetric and COVID-19-Related Morbidity and Mortality in Three Patients with Sickle Hemoglobinopathy

“…1 In the Jamaican pregnant population, 2.8% of women have SCD. 2 This group of disorders is highly associated with increased maternal morbidity/mortality, 3 with the most common cause of maternal death being acute chest syndrome (ACS). 2 …”

“…2 This group of disorders is highly associated with increased maternal morbidity/mortality, 3 with the most common cause of maternal death being acute chest syndrome (ACS). 2 COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was officially declared a pandemic in March 2020. Patients with chronic medical illnesses are prone to severe disease/mortality.…”