ABSTRACT
BACKGROUND: People with sickle cell disease (SCD) or sickle cell trait (SCT) may not have information about genetic inheritance needed for making informed reproductive health decisions. CHOICES is a Web-based, multimedia educational intervention that provides information about reproductive options and consequences to help those with SCD or SCT identify and implement an informed parenting plan. Efficacy of CHOICES compared with usual care must be evaluated. OBJECTIVE: The purpose was to compare immediate posttest effects of CHOICES versus an attention-control usual care intervention (e-Book) on SCD-/SCT-related reproductive health knowledge, intention, and behavior. METHODS: In a randomized controlled study, we recruited subjects with SCD/SCT from clinics, community settings, and online networks with data collected at sites convenient to the 234 subjects with SCD (n = 136) or SCT (n = 98). Their ages ranged from 18 to 35 years; 65% were women, and 94% were African American. Subjects completed a measure of sickle cell reproductive knowledge, intention, and behavior before and immediately after the intervention. RESULTS: Compared with the e-Book group, the CHOICES group had significantly higher average knowledge scores and probability of reporting a parenting plan to avoid SCD or SCD and SCT when pretest scores were controlled. Effects on intention and planned behavior were not significant. The CHOICES group showed significant change in their intention and planned behavior, whereas the e-Book group did not show significant change in their intention, but their planned behavior differed significantly. DISCUSSION: Initial efficacy findings are encouraging but warrant planned booster sessions and outcome follow-ups to determine sustained intervention efficacy on reproductive health knowledge, intention, and actual behavior of persons with SCD/SCT.
Subject(s)
Anemia, Sickle Cell , Black or African American , Family Planning Services , Patient Education as Topic/methods , Reproductive Health , Adolescent , Adult , Anemia, Sickle Cell/ethnology , Anemia, Sickle Cell/nursing , Female , Health Knowledge, Attitudes, Practice , Humans , Intention , Internet , Male , Multimedia , Problem-Based Learning , United StatesABSTRACT
The term sickle cell disease (SSD) encompasses several different sickle hemoglobinopathies. The ability to predict the clinical course of SSD during pregnancy is difficult. This article examines pregnancy-associated complications in SSD and the management of sickle cell disorders in pregnant women. Outcomes have improved for pregnant women with SSD and nowadays the majority can achieve a successful live birth. However, pregnancy is still associated with an increased incidence of morbidity and mortality. Optimal management during pregnancy should be directed at preventing pain crises, chronic organ damage, optimization of fetal health and minimizing early maternal mortality using a multidisciplinary team approach and prompt, effective and safe relief of acute pain episodes.
Subject(s)
Anemia, Sickle Cell , Pregnancy Complications, Hematologic , Analgesia , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/genetics , Anemia, Sickle Cell/therapy , Delivery, Obstetric , Female , Fetal Diseases/epidemiology , Fetal Diseases/etiology , Fetal Diseases/therapy , Gestational Age , Humans , Labor, Obstetric , Preconception Care , Pregnancy , Pregnancy Complications, Hematologic/therapy , Pregnancy Outcome , Puerperal DisordersABSTRACT
OBJECTIVE: The objective of the study was to investigate the effect of MgSO4 infusion on central arterial compliance, using radial artery applanation tonometry in women with preeclampsia. STUDY DESIGN: Seventy women with preeclampsia were prospectively recruited. Radial pulse waveforms were obtained and the aortic waveforms constructed. The arterial compliance surrogates, augmentation pressure (AP) and augmentation index (AIx-75), were derived from the aortic waveform and then compared: prior to MgSO4 (t1), 1 hour after MgSO4 bolus (t2), 4 hours after MgSO4 infusion (t3), and 24 hours after MgSO4 cessation (t4). Statistical analysis was performed using differences of least squared means with Tukey Kramer adjustments. RESULTS: The AP and AIx-75 at t2-t4 were significantly lower compared with t1, with the greatest decrease in arterial stiffness at t3 (P<.05). CONCLUSION: In preeclampsia, MgSO4 improved central arterial compliance. This effect was most exaggerated after 4 hours of infusion and remained 24 hours following MgSO4 completion, suggesting either a sustained arterial compliance effect or resolution of the vasoconstrictive effect of preeclampsia.
