Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Illinois, USA.
Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA.
Acta Obstet Gynecol Scand. 2023 Aug;102(8):1100-1105. doi: 10.1111/aogs.14622. Epub 2023 Jun 26.
Sickle cell trait (SCT) is common in African descendants. Its association with several adverse pregnancy outcomes (APOs) has been reported but remains inconsistent. The objectives of this study are to test associations of SCT with APOs in non-Hispanic Black women, including (1) validate the associations of SCT with previously reported APOs, (2) test novel associations of SCT with broad spectrum of APOs, and (3) estimate the attributable risk of SCT for implicated APOs.
This is a retrospective analysis of a prospectively designed population-based cohort. Women/participants were self-reported non-Hispanic Black women from the UK Biobank (UKB). SCT status was determined based on heterozygous Glu6Val in the HBB gene. Several APOs were studied, including four previously reported SCT-associated APOs (preeclampsia, bacteriuria, pregnancy loss, and preterm delivery), and broad conditions related to pregnancy, childbirth, and the puerperium. APOs were curated by experts' peer review and consensus processes. Associations of SCT with APOs were tested by estimating its relative risk and 95% confidence interval (95% CI), adjusting for number of live births and age at first birth. Attributable risk proportion (ARP) and population attributable risk proportion (PARP) of SCT to APOs were estimated.
Among the 4057 self-reported non-Hispanic Black women with pregnancy records in the UKB, 581 (14.32%) were SCT carriers. For four previously reported SCT-associated APOs, two were confirmed at a nominal P < 0.05; relative risk (RR) was 2.39 (95% CI 1.09-5.23) for preeclampsia, and 4.85 (95% CI 1.77-13.27) for bacteriuria. SCT contributed substantially to these two APOs among SCT carriers, with attributable risk proportion estimated at 61.00% and 68.96% for preeclampsia and bacteriuria, respectively. SCT also contributed substantially to these two APOs in the population (self-reported Black UK women), with population attributable risk proportion estimated at 18.30% and 24.14% for preeclampsia and bacteriuria, respectively. In addition, novel associations were found for seven other APOs (nominal P < 0.05).
SCT is significantly associated with APOs in this study and contributes substantially to APOs among self-reported Black women in the UK. Confirmation of these findings in independent study populations is required.
镰状细胞特征（SCT）在非洲裔后裔中很常见。已有报道称，其与多种不良妊娠结局（APO）相关，但结果仍不一致。本研究的目的是在非西班牙裔黑人女性中检验 SCT 与 APO 的关联，包括（1）验证 SCT 与先前报道的 APO 的关联，（2）检验 SCT 与广泛的 APO 的新关联，以及（3）估计 SCT 对相关 APO 的归因风险。
这是一项前瞻性设计的基于人群队列的回顾性分析。参与者为英国生物银行（UKB）中自我报告的非西班牙裔黑人女性。SCT 状态基于 HBB 基因中 Glu6Val 的杂合子确定。研究了几种 APO，包括先前报道的与 SCT 相关的四个 APO（子痫前期、菌尿、妊娠丢失和早产），以及与妊娠、分娩和产褥期相关的广泛情况。APO 通过专家同行评审和共识过程进行了整理。通过估计相对风险和 95%置信区间（95%CI）来检验 SCT 与 APO 的关联，调整了活产数和首次分娩年龄。估计了 SCT 对 APO 的归因风险比例（ARP）和人群归因风险比例（PARP）。
在 UKB 中有妊娠记录的 4057 名自我报告的非西班牙裔黑人女性中，有 581 名（14.32%）为 SCT 携带者。对于先前报道的四个与 SCT 相关的 APO，两个在名义 P 值<0.05 时得到确认；子痫前期的相对风险（RR）为 2.39（95%CI 1.09-5.23），菌尿为 4.85（95%CI 1.77-13.27）。在 SCT 携带者中，SCT 对这两个 APO 有很大贡献，估计的归因风险比例分别为子痫前期和菌尿的 61.00%和 68.96%。SCT 对这些两个 APO 在人群中（自我报告的英国黑人女性）也有很大贡献，估计的人群归因风险比例分别为子痫前期和菌尿的 18.30%和 24.14%。此外，还发现了另外七个 APO 的新关联（名义 P 值<0.05）。
在本研究中，SCT 与 APO 显著相关，并在英国自我报告的黑人女性中对 APO 有很大贡献。需要在独立的研究人群中确认这些发现。
