Sickle cell disease and pregnancy outcomes: a study of the community-based hospital in a tribal block of Gujarat, India

Abstract

BackgroundSickle cell disease (SCD) is a hereditary blood disorder prevalent in tribal regions of India. SCD can increase complications during pregnancy and in turn negatively influence pregnancy outcomes. This study reports the analysis of tribal maternal admissions in the community-based hospital of SEWA Rural (Kasturba Maternity Hospital) in Jhagadia block, Gujarat. The objective of the study is to compare the pregnancy outcomes among SCD, sickle cell trait and non-SCD admissions. This study also estimated the risk of adverse pregnancy outcomes for SCD admissions.MethodsThe data pertains to four and half years from March 2011 to September 2015. The total tribal maternal admissions were 14640, out of which 10519 admissions were deliveries. The admissions were classified as sickle cell disease, sickle cell trait and non-sickle cell disease. The selected pregnancy outcomes and maternal complications were abortion, stillbirth, Caesarean section, haemoglobin levels, blood transfusion, preterm pregnancy, newborn birth weight and other diagnosed morbidities (IUGR, PIH, eclampsia, preterm labour pain). The odds ratios for each risk factor were estimated for sickle cell patients. The odds ratios were adjusted for the respective years.ResultsOverall, 1.2% (131 out of 10519) of tribal delivery admissions was sickle cell admissions. Another 15.6% (1645 out of 10519) of tribal delivery admissions have sickle cell trait. The percentage of stillbirth was 9.9% among sickle cell delivery admission compared to 4.2% among non-sickle cell deliveries admissions. Among sickle cell deliveries, 70.2% were low birth weight compared to 43.8% of non-sickle cell patient. Similarly, almost half of the sickle cell deliveries needed the blood transfusion. The 45.0% of sickle cell delivery admissions were pre-term births, compared to 17.3% in non-SCD deliveries. The odds ratio of severe anaemia, stillbirth, blood transfusion, Caesarean section, and low birth weight was significantly higher for sickle cell admissions compared to non-sickle cell admissions.ConclusionsThe study exhibited that there is a high risk of adverse pregnancy outcomes for women with SCD. It may also be associated with the poor maternal and neonatal health in these tribal regions. Thus, the study advocates the need for better management of SCD in tribal Gujarat.

Fetomaternal outcome in sickle cell hemoglobinopathy in a tertiary care centre of North Kerala, India

“…We had 56.94% babies less than 2.5 kg at birth similar to the higher rates observed earlier. 11,16,17,[20][21][22]24 Low Apgar score of 11% by Silva-Pinto et al and 34.5% by Muganyizi et al has been reported in babies born to SCD mothers, while we had 14.49% babies with low Apgar. 16,24 Because of prematurity, low birth weight and perinatal asphyxia due to IUGR, there was a high rate of neonatal ICU admissions.…”

“…17 This study also showed a higher incidence of eclampsia in consistent with an earlier metaanalysis and also reports from other states of India. 9,11,20 Intrauterine growth restriction was seen in more than onethird of the SCD women and such a higher incidence was shown in literature. 17,18,21 Chronic maternal anemia and hypertension in pregnancy resulting in reduced placental perfusion is the most likely reason for intrauterine growth restriction.…”

“…11 More than 60% of sickle cell deliveries required blood transfusion with about a third of the total patients requiring three or more transfusions which was very high comparing with 52.7% transfusions as reported recently by Desai G et al with only 8.4% requiring 3 or more transfusions. 20 Sickle cell crisis, one of the acute complication of SCD has been shown to increase antepartum hospital admissions. 19,21 Pregnancy has been shown to exacerbate sickle cell crises with as high as 100% incidence of vasoocclusive crisis in pregnant women with SCD.…”

“…12,22,24 Women with sickle cell hemoglobinopathy have been found to have a higher risk for preterm delivery. [9][10][11][12][15][16][17]20,21 According to Desai G et al and Ugobama et al, the incidence of preterm birth was as high as 44-45%. 12,20 Our incidence was 18.06% which was consistent with the 2-fold increased risk in SCD women.…”

Complications and Outcomes of Pregnancy in Women With Sickle Cell Anaemia- A Study Conducted in a Tertiary Care Centre in North Kerala

“…2 Many studies have shown that pregnancy in sickle cell anaemia is associated with increased risk of maternal and foetal morbidity and mortality. 3,4,5,6 There is little data on the maternal, foetal and perinatal outcomes of women with sickle cell anaemia in India. No such studies were conducted in Kerala.…”