Sickle cell disease and increased adverse maternal and perinatal outcomes in different genotypes

Camilla Olivares Figueira; José Paulo S Guida; Fernanda G Surita; Arthur Antolini-Tavares; Sara T Saad; Fernando F Costa; Kleber Y Fertrin; Maria Laura Costa

doi:10.1016/j.htct.2024.02.013

Sickle cell disease and increased adverse maternal and perinatal outcomes in different genotypes

Hematol Transfus Cell Ther. 2024 Mar 14:S2531-1379(24)00056-7. doi: 10.1016/j.htct.2024.02.013. Online ahead of print.

Authors

Camilla Olivares Figueira¹, José Paulo S Guida¹, Fernanda G Surita¹, Arthur Antolini-Tavares², Sara T Saad³, Fernando F Costa³, Kleber Y Fertrin⁴, Maria Laura Costa⁵

Affiliations

¹ Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil.
² Department of Pathological Anatomy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil.
³ Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil.
⁴ Division of Hematology, Department of Medicine, University of Washington, WA 98195, Seattle, WA, USA.
⁵ Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil. Electronic address: mlaura@unicamp.br.

PMID: 38494406
DOI: 10.1016/j.htct.2024.02.013

Abstract

Background: Sickle cell disease (SCD) comprises a heterogeneous group of inherited hemolytic disorders that increases the risk of maternal and perinatal complications due to chronic systemic inflammatory response, endothelial damage and vaso-occlusion. The contribution of genotypes to the severity of outcomes during pregnancy is not completely established.

Methods: A retrospective study of medical charts was performed to compare maternal and perinatal outcomes in Hb SS, Hb SC disease and sickle-beta thalassemia (Hb Sβ) pregnancies followed at a high-risk antenatal care unit over a 6-year period. A descriptive analysis of morphological findings was performed of the placenta when pathology reports were available.

Results: Sixty-two SCD pregnant women [25 Hb SS (40 %), 29 Hb SC (47 %) and 8 Hb Sβ (13 %)] were included. Overall, SCD was associated with maternal complications (77 %), preterm birth (30 %), cesarean section (80 %) and a need of blood transfusion. In general there were no statistically significant differences between genotypes. The only significant difference was the hemoglobin level at first antenatal care visit which was lower for the homozygous genotype (7.7 g/dL) compared to Hb SC and Hb Sβ (9.7 g/dL and 8.4 g/dL, respectively; p-value = 0.01). Ten of 15 evaluated placentas showed abnormal morphological findings CONCLUSION: SCD, regardless of the underlying genotype, is associated with increased adverse maternal and perinatal outcomes and placental abnormalities associated with maternal vascular malperfusion.

Keywords: Anemia; Placenta; Pregnancy; Sickle cell disease; Transfusion.