Sickle Cell Disease in Pregnancy: Maternal Complications in a Medicaid-Enrolled Population

Abstract

Higher frequencies of pregnancy complications have been reported among women with sickle cell disease (SCD) compared with those without SCD; however, past studies are limited by small sample size, narrow geographic area, and use of hospital discharge data. We compared the prevalence of maternal complications among intrapartum and postpartum women with SCD to those without SCD in a large, geographically diverse sample. Data from the 2004-2010 Truven Health MarketScan ® Multi-State Medicaid databases were used to assess the prevalence of maternal complications among intrapartum and postpartum women 15-44 years of age with and without SCD whose race was reported as black. The comparison group of women without SCD was further divided into those with chronic conditions associated with multi-organ failure and those without chronic conditions. Multivariable log-binomial regression models were used to calculate adjusted prevalence ratios for outcomes for women with SCD compared with women in the two comparison groups. Of the 335,348 black women with a delivery during 2004-2010, 1,526 had a diagnosis of SCD (0.5 %). Compared with women without SCD who had chronic conditions, women with SCD had higher prevalence of deep vein thrombosis, pulmonary HHS Public Access Author manuscriptMatern Child Health J. Author manuscript; available in PMC 2015 April 13. Author ManuscriptAuthor Manuscript Author ManuscriptAuthor Manuscript embolism, obstetric shock, pneumonia, sepsis, postpartum infection, and transfusions. SCD was also positively associated with acute renal failure, cerebrovascular disorder, respiratory distress syndrome, eclampsia, postpartum hemorrhage, preterm birth, and ventilation when compared with women without SCD and chronic conditions. Overall, women with SCD have increased prevalence of pregnancy complications, even when compared with a group of women with similar risk for multi-organ failure.

Pulmonary Complications of Sickle Cell Disease in the Pregnant Patient

“…One large retrospective study analyzing the Medicaid-enrolled population with SCD showed increased rates for pregnancy complications that include cerebral vein thrombosis, pneumonia, pyelonephritis, deep-vein thrombosis, PE, and the sepsis syndrome [8]. Such findings corroborate an earlier retrospective study that looked at over 4,000 pregnancies of SCD mothers -who reported increased rates of maternal renal failure, gestational hypertension, and fetal-growth restriction [9].…”

Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis

“…[24][25][26][27][28][29][30][31] All studies were categorized as pregnancy cohort studies. Thirteen studies originated For personal use only.…”

The ethics of a proposed study of hematopoietic stem cell transplant for children with “less severe” sickle cell disease

“…39,51 Although the long-term prognosis of children with initially less severe SCD may be better (especially in the future with continued improvements in supportive care), an individual patient's disease course is likely to involve significant problems. The specific risk of infertility secondary to HSCT also has to be balanced with the risk of reproductive problems related to SCD complications (impotence from priapism for men, [52][53][54] increased pregnancy complications for women [55][56][57] ) and also weighed against hydroxyurea therapy toxicity. 44,58,59 Thus, given the serious problems caused by SCD, some have questioned: Is the medical community actually harming patients with SCD by not offering them a curative therapy (HSCT) early and forcing these patients to live with a disease that causes high morbidity and premature mortality?…”