Abrams Christina M, Foster Caroline B, Davila Natalia, Reneau Marcelaine, Felder Earleisha, Mueller Martina, Davila Caroline
From the Department of Pediatrics, Division of Hematology/Oncology.
the Department of Public Health Sciences.
South Med J. 2025 Feb;118(2):91-96. doi: 10.14423/SMJ.0000000000001784.
Sickle cell disease (SCD), which disproportionately affects minorities, increases complications during pregnancy. Severe maternal mortality is increased in women with SCD, including morbidity related to the disease and other nondisease-related complications. It also can have devastating complications for fetuses, with increases in premature birth and low birth weight. This study aimed to describe the characteristics of women with SCD in South Carolina, with a specific focus on fetal and maternal outcomes and complications. The secondary aim of this study was to identify the effect of maternal characteristics on birth outcomes, including social determinants of health.
A secondary analysis of women from a single institution, the Medical University of South Carolina, which was part of the registry from the multi-institutional Sickle Cell Disease Implementation Consortium, was conducted. Patient demographics, self-reported pregnancy history, hydroxyurea use, and maternal and fetal outcomes were collected from patient-reported survey data. In addition, the number of vaso-occlusive episodes surrounding their pregnancies was collected for analysis.
Fifty-nine percent (116/195) of the female participants reported ever being pregnant. Seventy-two percent had live births, 15.8% had miscarriages, 1.8% had stillbirths, and 6.1% had an abortion. The mean age was 22.3 ± 4 years, with no difference in markers of severity between the groups. Most women were HbSS genotype with high rates of pain in the last year. No difference was found in age, education, employment, or income between these groups of women. Women in the nonlive birth cohort had higher body weights (78.7 versus 72.1 kg, = 0.045). The Distressed Community Index was used as a marker for social determinants of health and was similar between the two groups, with a majority of both cohorts (61.7% and 52%) living in "at risk" and "distressed" communities. Complications related to SCD were high, including 43% of women experiencing pain during pregnancy, 5.2% developing acute chest syndrome, and 22.4% requiring transfusion. An additional 11% experienced preeclampsia. Unfavorable infant outcomes included 49% of the infants being premature and 40% having babies weighing less than 5.5 lb at birth.
High rates of complications to both mother and infant were found in the women with SCD. Although few statistically significant predictors were found, by identifying and addressing specific needs of pregnant women with SCD, we can work toward reducing fetal and maternal mortality in an already vulnerable population.
镰状细胞病（SCD）对少数族裔的影响尤为严重，会增加孕期并发症。患有SCD的女性严重孕产妇死亡率会升高，包括与该疾病相关的发病率以及其他与疾病无关的并发症。它对胎儿也可能产生毁灭性的并发症，会增加早产和低出生体重的发生率。本研究旨在描述南卡罗来纳州患有SCD的女性的特征，特别关注胎儿和母亲的结局及并发症。本研究的次要目的是确定母亲特征对出生结局的影响，包括健康的社会决定因素。
对来自南卡罗来纳医科大学这一单一机构的女性进行了二次分析，该机构是多机构镰状细胞病实施联盟登记处的一部分。从患者报告的调查数据中收集患者人口统计学信息、自我报告的妊娠史、羟基脲使用情况以及母婴结局。此外，收集她们孕期周围血管闭塞发作的次数进行分析。
59%（116/195）的女性参与者报告曾怀孕。72%有活产，15.8%有流产，1.8%有死产，6.1%有堕胎。平均年龄为22.3±4岁，各组之间严重程度指标无差异。大多数女性为HbSS基因型，去年疼痛发生率较高。这些女性群体在年龄、教育程度、就业或收入方面未发现差异。非活产队列中的女性体重更高（78.7对72.1千克，P = 0.045）。使用困境社区指数作为健康社会决定因素的指标，两组之间相似，两个队列中的大多数（61.7%和52%）生活在“有风险”和“困境”社区。与SCD相关的并发症发生率很高，包括43%的女性在孕期经历疼痛，5.2%发生急性胸综合征，22.4%需要输血。另外11%经历了先兆子痫。不良婴儿结局包括49%的婴儿早产，40%的婴儿出生时体重低于5.5磅。
患有SCD的女性中母婴并发症发生率很高。尽管几乎没有发现具有统计学意义的预测因素，但通过识别和满足患有SCD的孕妇的特定需求，我们可以努力降低这个本就脆弱群体中的胎儿和孕产妇死亡率。
