Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia.
Division of Reproductive Endocrinology and Infertility, Penn State College of Medicine and Penn State Health, Hershey, Pennsylvania.
JAMA Netw Open. 2021 Nov 1;4(11):e2134274. doi: 10.1001/jamanetworkopen.2021.34274.
Relative to what is known about pregnancy complications and sickle cell disease (SCD), little is known about the risk of pregnancy complications among those with sickle cell trait (SCT). There is a lack of clinical research among sickle cell carriers largely due to low sample sizes and disparities in research funding.
To evaluate whether there is an association between SCT and a stillbirth outcome.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included data on deliveries occurring between January 1, 2010, and August 15, 2017, at 4 quaternary academic medical centers within the Penn Medicine health system in Pennsylvania. The population included a total of 2482 deliveries from 1904 patients with SCT but not SCD, and 215 deliveries from 164 patients with SCD. Data were analyzed from May 3, 2019, to September 16, 2021.
The primary exposure of interest was SCT, identified using clinical diagnosis codes recorded in the electronic health record.
A multivariate logistic regression model was constructed to assess the risk of stillbirth using the following risk factors: SCD, numbers of pain crises and blood transfusions before delivery, delivery episode (as a proxy for parity), prior cesarean delivery, multiple gestation, patient age, marital status, race and ethnicity, ABO blood type, Rhesus (Rh) factor, and year of delivery.
This cohort study included 50 560 patients (63 334 deliveries), most of whom were aged 25 to 34 years (29 387 of 50 560 [58.1%]; mean [SD] age, 29.5 [6.1] years), were single at the time of delivery (28 186 [55.8%]), were Black or African American (23 777 [47.0%]), had ABO blood type O (22 879 [45.2%]), and were Rhesus factor positive (44 000 [87.0%]). From this general population, 2068 patients (4.1%) with a sickle cell gene variation were identified: 1904 patients (92.1%) with SCT (2482 deliveries) and 164 patients (7.9%) with SCD (215 deliveries). In the fully adjusted model, SCT was associated with an increased risk of stillbirth (adjusted odds ratio [aOR], 8.94; 95% CI, 1.05-75.79; P = .045) while adjusting for the risk factors of SCD (aOR, 26.40; 95% CI, 2.48-280.90; P = .007) and multiple gestation (aOR, 4.68; 95% CI, 3.48-6.29; P < .001).
The results of this large, retrospective cohort study indicate an increased risk of stillbirth among pregnant people with SCT. These findings underscore the need for additional risk assessment during pregnancy for sickle cell carriers.
与已知的妊娠并发症和镰状细胞病（SCD）相比，关于镰状细胞特征（SCT）患者妊娠并发症风险的了解甚少。由于样本量小和研究资金差异，镰状细胞携带者的临床研究很少。
评估 SCT 是否与死产结局有关。
设计、设置和参与者：这是一项回顾性队列研究，纳入了 2010 年 1 月 1 日至 2017 年 8 月 15 日期间在宾夕法尼亚州宾州医学院健康系统的 4 家四级学术医疗中心发生的分娩数据。该人群包括 1904 名 SCT 但无 SCD 的患者共 2482 例分娩，以及 164 名 SCD 患者共 215 例分娩。数据分析于 2019 年 5 月 3 日至 2021 年 9 月 16 日进行。
主要暴露因素是 SCT，通过电子病历记录的临床诊断代码确定。
使用以下风险因素构建多变量逻辑回归模型来评估死产风险：SCD、分娩前疼痛危机和输血次数、分娩事件（作为产次的替代指标）、先前剖宫产、多胎妊娠、患者年龄、婚姻状况、种族和民族、ABO 血型、Rh 因子和分娩年份。
这项队列研究包括 50560 名患者（63334 例分娩），其中大多数年龄在 25 至 34 岁之间（50560 名中的 29387 名[58.1%]；平均[SD]年龄为 29.5[6.1]岁），在分娩时单身（28186 名[55.8%]），为黑种人或非裔美国人（23777 名[47.0%]），ABO 血型为 O 型（22879 名[45.2%]），Rh 因子阳性（44000 名[87.0%]）。在一般人群中，确定了 2068 名患有镰状细胞基因突变的患者：1904 名（92.1%）为 SCT（2482 例分娩）和 164 名（7.9%）为 SCD（215 例分娩）。在完全调整的模型中，SCT 与死产风险增加相关（调整后的优势比[aOR]，8.94；95%CI，1.05-75.79；P=0.045），同时调整了 SCD（aOR，26.40；95%CI，2.48-280.90；P=0.007）和多胎妊娠（aOR，4.68；95%CI，3.48-6.29；P<0.001）的风险因素。
这项大型回顾性队列研究的结果表明，SCT 孕妇的死产风险增加。这些发现强调了需要在镰状细胞携带者怀孕期间进行额外的风险评估。
