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Obstetrics & Gynecology:
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Pregnancy in Sickle Cell Disease: Experience of the Cooperative Study of Sickle Cell Disease.

SMITH, JEANNE A. MD, MPH; ESPELAND, MARK PhD; BELLEVUE, RITA MD; BONDS, DUANE MD; BROWN, AUDREY K. MD; KOSHY, MABEL MD

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Abstract

Objective: To determine the maternal and fetal outcomes of pregnancy in women with sickle cell disease.

Methods: The subjects were part of a cohort recruited from 19 centers for a prospective study of the clinical course of sickle cell disease. Each participant was evaluated using a structured protocol in which steady-state data and information on both sickle- and non-sickle-related events were colleted. The rates of antepartum and intrapartum complications were tallied for pregnancies carried to delivery. Fetal outcome was assessed according to gestational age, birth weight, and Apgar score. Differences among genotypes in event rates were assessed using Fisher exact test. Differences in gestational age and birth weight, and predictors of these outcomes, were assessed using analyses of covariance.

Results: Two hundred eighty-six of the 445 reported pregnacies proceeded to delivery. Non-sickle-related antepartum and intrapartum complication rates were comparable with those of African-American women who did not have sickle cell disease. One of the two deaths observed during this study was directly related to the presence of sickle cell disease. Rates of maternal morbidity from sickle cell disease were the same during pregancy as during the nonpregnant state. Ninety-nine percent of those pregnancies carried to delivery resulted in a live birth. Twenty-one percent of the infants born to women of the SS genotype were small for gestational age (SGA). Preclampsia and acute anemic events were identified as risk factors for SGA infants.

Conclusion: Those caring for women with sickle cell disease should support them if they desire to have children.

(C) 1996 The American College of Obstetricians and Gynecologists

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