ABSTRACT
OBJECTIVES: Sickle cell disease (SCD) occurs in 2.8â¯% of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. METHODS: A retrospective comparative analysis of HbSS, HbSC and HbSßThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. RESULTS: Of 120 patients (138 pregnancies), obesity occurred in 36â¯% (20/56) of the 'non-HbSS' group, i.e. HbSßThal (55â¯%, 5/9) and HbSC (32â¯%, 15/47) combined vs. 9.7â¯% of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal 'near-misses' (OR=10.7, 95â¯% 3.5-32.3; p<0.001), hospitalizations (OR 7.6, 95â¯% CI 3.4-16.9; p<0.001), low birth weight (LBW) neonates (OR 3.1, 1.1-8.9; p=0.037) and preterm birth (OR=2.6, 1.2-5.8; p=0.018) compared to HbSC and HbSßThal. Low dose aspirin was prescribed in 43â¯%. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2â¯%), were LESS likely to have a live birth (75 v. 95â¯% (0.2, 0.04-0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46â¯% (0.5, 0.03-0.9, p=0.03)). CONCLUSIONS: HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.
