Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana.
Am J Hematol. 2019 Feb;94(2):223-230. doi: 10.1002/ajh.25356. Epub 2018 Dec 5.
In Africa, the maternal mortality rate in sickle cell disease (SCD) is ~10%. Our team previously demonstrated an 89% decrease in mortality rate in a before-and-after feasibility study among women with SCD living in low-resource setting in Ghana. In the same cohort including additional participants with and without SCD, we used a prospective cohort design to test the hypothesis that implementing a multidisciplinary care team for pregnant women with SCD in low-resource setting will result in similar maternal and perinatal mortality rates compared to women without SCD. We prospectively enrolled pregnant women with and without SCD or trait and followed them up for 6-week postpartum. We tested the newborns of mothers with SCD for SCD. We recruited age and parity matched pregnant women without SCD or trait as the comparison group. Maternal and perinatal mortality rates were the primary outcomes. A total of 149 pregnant women with SCD (HbSS, 54; HbSC, 95) and 117 pregnant women without SCD or trait were included in the analysis. Post-intervention, maternal mortality rates were 1.3% and 0.9% in women with and without SCD, respectively (P = 1.00); the perinatal mortality rates were 7.4% and 3.4% for women with and without SCD, respectively (P = 0.164). Among the mothers with SCD, ~15% of newborns had SCD. Multidisciplinary care of pregnant women with SCD may reduce maternal and perinatal mortality rates to similar levels in pregnant women without SCD in low-resource settings. Newborns of mothers with SCD have a high rate of SCD.
在非洲，镰状细胞病（SCD）的孕产妇死亡率约为 10%。我们的团队之前在加纳的一个资源匮乏环境中进行了一项前后可行性研究，结果显示 SCD 女性的死亡率降低了 89%。在同一队列中，包括了更多患有和不患有 SCD 的参与者，我们使用前瞻性队列设计来检验这样一个假设，即在资源匮乏的环境中为患有 SCD 的孕妇组建一个多学科护理团队，是否会导致与不患有 SCD 的女性相似的孕产妇和围产期死亡率。我们前瞻性地招募了患有和不患有 SCD 或性状的孕妇，并对她们进行了为期 6 周的产后随访。我们对 SCD 母亲的新生儿进行了 SCD 检测。我们招募了年龄和孕次匹配的不患有 SCD 或性状的孕妇作为对照组。孕产妇和围产期死亡率是主要结局。共有 149 名患有 SCD（HbSS，54 例；HbSC，95 例）的孕妇和 117 名不患有 SCD 或性状的孕妇纳入分析。干预后，患有 SCD 的女性的孕产妇死亡率分别为 1.3%和 0.9%（P=1.00）；患有 SCD 的女性的围产期死亡率分别为 7.4%和 3.4%（P=0.164）。在患有 SCD 的母亲中，约 15%的新生儿患有 SCD。在资源匮乏的环境中，对 SCD 孕妇进行多学科护理可能会降低孕产妇和围产期死亡率，使其与不患有 SCD 的孕妇的死亡率相当。患有 SCD 的母亲的新生儿 SCD 发生率较高。
