Investigators Call for Education, Sickle Cell Disease-Modifying Therapies for Pregnant Women

Oyebimpe Adesina, MD

It's known that women with sickle cell disease (SCD) experience adverse pregnancy outcomes worldwide. This also applies to the US, where Black women are at a significantly higher risk of worse maternal health outcomes compared with all other racial demographics.

In order to expand on the understanding of the social role of maternal morbidity in those with sickle cell disease, Oyebimpe Adesina, MD, Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, and a team of investigators decided to evalute the cumulative incidence of pregnancy outcomes in this population.

Sickle cell disease has evolved from a diagnosis equivalent with childhood mortality to a chronic illness characterized by acute complications and cumulative morbidity across the lifespan, according to investigators. With public health efforts and therapeutic advancements the prognosis for this rare condition has progressed, but longer life expectancy has highlighted a multitude of areas that need attention in this population.

How Does Sickle Cell Disease Factor into Maternal Mortality Outcomes?

Currently, many Americans living with sickle cell disease are living into their 40s and 50s, most of which are of African or Hispanic ancestry. This comes with potential pregnancy complications particularly for pregnant women living with sickle cell disease.

On its own, the physiological demands and metabolic stressors of pregnancy have some risk, but when combined with endothelial activation and cytokine-mediated inflammation exacerbating the chronic hemolysis, microvascular occlusion, and hypercoagulability of sickle cell disease, those risks are significant.

In order to estimate the cumulative incidence of pregnancy outcomes in Black women with and without SCD, investigators adjusted for age, insurance status, and Distressed Community Index (DCI) scores based on California's Department of Health Care Access and Information data from 1991–2019.

The likelihood of delivering at a young age in Black pregnant women with SCD was higher, with the use government insurance, as well as the risk of these women living in at-risk or distressed neighborhoods, compared to those without SCD. Still-births and inpatient births were also statistically higher in this population.

Pregnancy Outcomes Among Patients with Sickle Cell Disease

Unfortunately, this population also poses a significantly higher risk for sepsis, venous thromboembolism, and postpartum hemorrage. This is particularly riskly with peak onset in the second and third trimester, and six-weeks postpartum.

Following adjustments for sociodemographic factors, Black women with sickle cell disease continued to exhibit statistically worse outcomes compared with those that didn't have sickle cell disease. While further research is needed to better understand the care and interventions needed, investigators urged for a more comprehensive education in reproductive health care, as well as guidance on the continuation of sickle cell disease modifying therapies throughout the duration of pregnancy.

Increased accessibility to multidisciplinary perinatal care can certainly reduce morbidity in pregnant women with sickle cell disease, according to investigators.

The study "Pregnancy outcomes in women with sickle cell disease in California" was published in the American Journal of Hematology.