Haematological risk factors for pregnancy outcome in Jamaican women with homozygous sickle cell disease.

OBJECTIVE

To examine the association between fetal outcome and the steady state haematology of mothers with homozygous sickle cell disease.

DESIGN

A retrospective observational study. The data were taken from dockets kept at the Sickle Cell Clinic and verified by interview with 45% of the patients.

SETTING

The Sickle Cell Clinic at the University Hospital of the West Indies or two peripheral clinics operated by the staff of the MRC Laboratories.

SUBJECTS

All women aged 14 years or older with homozygous sickle cell disease who had experienced at least one pregnancy in the period 1977 to 1986.

MAIN OUTCOME MEASURES

Three fetal outcomes including miscarriages, perinatal deaths, and birthweight.

RESULTS

There were 270 singleton pregnancies in 175 women with an overall fetal wastage of 32.2%. There was a significant increased risk of perinatal death with low maternal fetal haemoglobin level, but there were no haematological associations with miscarriages or birthweight.

CONCLUSIONS

These data suggest that maternal steady-state haematology has little influence on fetal outcome, with the exception that mothers with high HbF levels are less prone to perinatal deaths. Further study is required to investigate acute haematological changes associated with pregnancy.