Pregnancy Outcomes among Patients with Sickle Cell Disease in Brazzaville

Abstract

Introduction. Sickle cell disease (SCD) is one of the most common genetic diseases in the world. It combines, in its homozygous form, chronic hemolytic anemia, vasoocclusive complications, and susceptibility to infections. It is well known that the combination of pregnancy and sickle cell disease promotes the occurrence of complications that are sometimes fatal for the mother and/or the fetus. Objective. The objective of the current study was to compare pregnancy outcomes among women with SCD with those of women without the diagnosis of SCD. Materials and methods. It was a case-control study carried out in four maternity hospitals in Brazzaville in 2 years (July 2017–June 2019). It concerned 65 parturients with SS homozygous SCD. The mode of childbirth and maternal and perinatal morbidity and mortality were compared with those of 130 non-sickle cell pregnant women. Results. The average age was 27 years for SCD women and 31 years for non-SCD women. The average gestational age at delivery was 35 weeks for SCD women and 38 weeks for non-SCD women. From the logistic regression analysis using the comparison group as the reference group, there was excessive risk in SCD compared to non-SCD of infection (29.3% vs. 4.6%, OR = 21.7, 95% CI [7.6–62.7]; p=0.001), cesarean (63% vs. 35.4%, OR = 3.1, 95% CI [1.6–5.7]; p=0.001), prematurity (75.4% vs. 30.8%, OR = 8, 95% CI [3.0–23.2]; p=0.001), low birth weight (52.3% vs. 16.1%, OR = 4.7, 95% CI [2.4–9.4]; p=0.001), neonatal requiring admission to the intensive care unit (40.3% vs. 17.5%, OR = 3.2, 95% CI [1.6–6.3]; p=0.01), and neonatal death (21.5% vs. 4.8%, OR = 4.3, 95% CI [1.5–12.2]; p=0.01). Conclusion. The risk of pregnancy in patients with homozygous sickle cell anemia remains high, on both the maternal and fetal sides.

Complicações materno-fetais em gestantes portadoras de doença falciforme

“…Essas complicações foram encontradas na maioria dos estudos. (Galiba Atipo Tsiba, et al 2020;Babah, et al 2019;Proske, et No estudo de Costa et al (2015), em que foram comparadas gestantes HbSS e HbSC, observaram-se bebês PIG (pequenos para idade gestacional) com mais frequência no grupo HbSS, assim como parto prematuro e internação em UTI neonatal. Wilson et al (2012) observaram risco reduzido em parto de gestantes HbSC com bebês de baixo peso ao nascer, quando comparadas com portadores de anemia falciforme e gestantes do grupo de comparação sem a doença.…”

“…O puerpério é uma fase com alto risco para descompensação da DF.A própria fadiga materna (tempo de trabalho de parto, período expulsivo prolongado), jejum com desidratação, trabalho muscular uterino e alcalose respiratória podem explicar esse fato. (Smith-Whitley, 2019) Além disso, a cesariana também pode ser um fator adicional, o que pode justificar o achado na pesquisa, já que mais da metade (63%) das gestantes em estudo tiveram como via de parto a cesariana (Galiba Atipo Tsiba, et al 2020).…”

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

“…Some variation in global maternal and perinatal mortality rates may be due to differences in SCD genotypes, other co-morbidities, maternal age and parity however in both developed and developing countries risk differences are similar between SCD and non-SCD women. 27 , 28 Where close foetal monitoring occurs during labor, with timely intervention, no excess risk of foetal mortality has been noted, 25 however MMRs six times higher than in the non-SCD population have been noted. 29 The still-birth rate of 12.5% among our SCD maternal deaths is similar to the 10% observed by Thame et al.…”

“… 44 In the Congo however, lower fertility (gravidity) and fecundity (parity) are evident in a setting where the TFR is 5.9. 27 …”

Hydroxyurea treatment for sickle cell anemia during pregnancy and lactation: Current evidence and knowledge gaps

“…As aforementioned, an increasing number of patients with SCA can now survive to childbearing age. Mounting evidence indicates that pregnancy with SCA is high risk and associated with increased morbidity and mortality for both mother and fetus 3,27–32 . One of the first studies reporting maternal and fetal outcomes in patients with SCA is a multicenter study conducted in the United Kingdom during 1991–1993 32 .…”