Fetal outcomes in pregnant women with sickle cell disease

OBJECTIVE: To investigate fetal outcomes in pregnant women with sickle cell disease (SCD), and to analyze the impact of baseline variables on those outcomes.

METHODS: This is a retrospective cohort study carried out over 5 years (June 2006 to August 2011) investigating fetal outcomes at Sultan Qaboos University Hospital, Muscat, Oman. Sixty-eight consecutive pregnant women with SCD (62 women with hemoglobin sickle cell anemia [SS] genotype) were included and analyzed in the study. Multivariable logistic regression was used to estimate the impact of baseline variables on major fetal complications (intrauterine growth restriction, intrauterine fetal death, and low birth weight babies, perinatal mortality, and admission to the neonatal unit).

RESULTS: The mean maternal age was 30 years +/-3.8. Mean gestational age at delivery was 37 weeks +/-1.8. The initial mean hemoglobin was 9.5 g/dl (standard deviation [SD] 1.1, range 7.2-11.9). The mean baseline hemoglobin F was 10.2 (SD 6.6, range 0.7-29). There were 11 cases (16.2%) of intrauterine growth restriction (95% confidence interval [CI]: 7.2-25.2), and 19 cases of fetal distress (27.9%; 95% CI: 17.0-38.9). Low birth weight was seen in 22 cases (32.4%, 95% CI: 20.9-43.8) with a mean weight of 2.6 Kg (SD: 0.47, range 1.2-3.9). There were 2 neonatal deaths. On multivariate logistic regression for a composite of fetal outcomes, none of those variables were of statistical significance.

CONCLUSION: The adverse fetal outcomes in pregnant women with SCD are high compared with the general population. There is no significant difference in fetal outcome between SCD, SS genotype versus others.