Prenatal anemia may be mediator linked to pregnancy risk in people with sickle cell disease

February 2, 2023

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Disclosure: There are no related financial disclosures. Pecker reports off-investigative personal expenses from Global Blood Therapeutics and Novo Nordisk and advisory roles to the Sickle Cell Reproductive Health Education Directive. See research for relevant financial disclosures of all other authors.

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According to a study published in , the odds of some adverse pregnancy outcomes appeared strikingly similar between pregnant women with anemia and those with sickle cell disease. JAMA network open.

Results showed that deliveries between both groups of people who were all identified as black had similar odds of complications specifically related to ischemia, cardiovascular stress or an abnormal placenta. I was.

 A clot of sickle cell blocks a blood vessel.
According to researchers, sickle cell anemia during pregnancy can have certain adverse consequences. Source: Adobe Stock

Preliminary data suggest that prenatal anemia may be a mediator associated with some of the increased risks of severe maternal morbidity and adverse pregnancy outcomes in pregnant women with sickle cell disease. There is, writes the researcher.

background, methodology

Pregnancy in people with sickle cell disease is considered to be at high risk. However, it remained unclear whether prenatal anemia, which can be treated with red blood cell transfusion, is a mediator associated with pregnancy complications.

“Currently, the only available treatment for pregnant women with sickle cell disease is red blood cell transfusion, which may be given temporarily (as needed) or chronically.” Macy L. Early, Bachelor, A medical student in the Department of Hematology, School of Medicine, Johns Hopkins University School of Medicine, and Lydia H. Pecker, MD The Director of the Young Adults Clinic at Johns Hopkins Adult Sickle Cell Center wrote in a statement to Helio: “There are also investigational and approved drugs to treat the anemia of sickle cell disease. The ASH sickle cell transfusion guidelines address indications for chronic transfusions, but of course anemia alone is not enough to treat sickle cell disease. It is not an indication for treatment in pregnant women. By comparing sickle cell patients with those with anemia, we wanted to investigate the extent to which anemia alone could adversely affect pregnancy.”

Using national inpatient sample data from 2012 to 2018, the researchers analyzed 764,455 maternity admissions among identified black patients (mean age at birth of 27 years, standard deviation of 6.08 years). bottom. who acted as the controller. Most women (65.4%) had public health insurance.

Another study of 5.4 million deliveries in a sample found that JAMA network openResearchers found that people with sickle cell disease had a higher rate of severe maternal morbidity than those without the disease, especially with respect to thrombotic events, organ failure, and death. A median risk of delivery of 28.9% for patients with erythropoiesis was explained by racial disparities.


In the current study, patients with sickle cell disease had a higher combined severe maternal morbidity (5.9%; 95% CI) than those with anemia (2.1%; 95% CI, 2-2.3) and those who received services. , 5.1-6.8) were higher. As controls (1.1%; 95% CI, 1-1.1), higher mortality per 10,000 births (13 deaths; 95% CI, 4.9-35 vs 0.9 deaths; 95% CI, 0.3-2.8 vs. 1.2 deaths; 95% CI, 1-1.5).

Compared with the control group, the adjusted odds ratio (aOR) for severe maternal morbidity was higher in the sickle cell group (aOR = 5.51; 95% CI, 4.71-6.45) and in the anemia group (aOR = 2; 95% CI, 1.84-) seemed higher. 2.17). However, the researchers noted overlap in aOR CIs for several complications associated with ischemia or abnormal placentation, such as eclampsia, between sickle cell disease and anemia groups. (aOR = 2.74; 95% CI, 1.51-4.96 vs 1.4; 95% CI, 1.08-1.81) and obstetric shock (aOR = 4.1; 95% CI, 2.26-7.44 vs 2.03; 95% CI, 1.53-2.7). The risk ratios for these complications in the sickle cell and anemia groups ranged from 1 to 2.1, including 1.76 (95% CI, 0.93-3.32) for eclampsia.

The sickle cell group also had higher incidence and aOR of complications related to thrombosis or sickle cell-specific conditions. Among them, acute respiratory distress syndrome, including acute chest syndrome, occurred in 56 of 3144 deliveries (1.8%) in the sickle cell group, compared with 122 of 34,686 deliveries in the anemia group. occurred twice (0.4%), with a risk ratio of 4.99. (95% CI, 3.65-6.84).

“We were surprised to be able to divide the complications into two groups: those with similar risks in pregnant people with sickle cell disease and those with anemia, and those with significantly higher risk in people with sickle cell disease. It’s been a while,” Early and Pecker told Helio. “This increases the likelihood that sickle cell anemia during pregnancy will cause certain adverse outcomes, while thrombophilia, hemolysis, and inflammation will cause other outcomes.

The associations presented in this study are limited by the administrative nature of the database, they noted.

Next steps, impact

According to Early and Pecker, multicenter clinical studies in pregnant women with sickle cell disease and those with anemia are needed to directly compare exposures and outcomes.

“It’s unclear how the pathophysiology of sickle cell disease, including chronic anemia, affects what we think of as ‘normal’ physiological adaptations to pregnancy,” they told Healio. Elucidating the physiology of erythrocytosis pregnancies will advance research and the use of interventions to improve outcomes.”


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