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Natural history of blood pressure in sickle cell disease pregnancy

Macy L Early1, Amy Luo2, Marissa Solow3,4

  • 1Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

British Journal of Haematology
|October 7, 2023
PubMed

Insights

Pregnant individuals with sickle cell disease (SCD) often have lower blood pressure than those without SCD. This may lead to underdiagnosis of hypertensive disorders of pregnancy (HDP) in this vulnerable population.

Area of Science:

  • Obstetrics and Gynecology
  • Hematology
  • Maternal-Fetal Medicine

Background:

  • Sickle cell disease (SCD) significantly impacts pregnancy outcomes.
  • Hypertensive disorders of pregnancy (HDP) are a major concern for pregnant individuals with SCD.
  • Understanding blood pressure patterns in SCD pregnancies is crucial for timely diagnosis and management.

Purpose of the Study:

  • To compare blood pressure values and trajectories in singleton pregnancies with SCD against a non-SCD control group.
  • To investigate potential differences in blood pressure and HDP rates across SCD genotypes (HbSS/HbSβ0 and HbSC/HbSβ+).
  • To explore the relationship between blood pressure, SCD genotype, and HDP incidence.

Main Methods:

  • Retrospective cohort study of 290 singleton pregnancies in individuals with SCD (1990-2021) at two academic centers.
  • Collected demographic, SCD-related data, pregnancy outcomes, and serial systolic and diastolic blood pressure (SBP and DBP) measurements.
  • Compared SCD cohort blood pressure data with a non-SCD pregnancy control dataset.

Main Results:

  • Sixteen percent of pregnancies with SCD experienced a hypertensive disorder of pregnancy (HDP), with no significant difference by genotype.
  • Mean SBP and DBP were consistently lower in the HbSS/HbSβ0 group compared to non-SCD controls.
  • Blood pressure trajectories in HbSS/HbSβ0 pregnancies mirrored controls, while HbSC/HbSβ+ pregnancies showed a dip and plateau in the second and third trimesters, respectively.

Conclusions:

  • Pregnant individuals with SCD generally exhibit lower blood pressure than their non-SCD counterparts.
  • The lower blood pressure in SCD pregnancies, particularly HbSS/HbSβ0, may mask or lead to underdiagnosis of HDP.
  • Further research is needed to refine diagnostic criteria for HDP in the context of SCD.

Keywords:
blood pressurehypertensive disorders of pregnancypregnancysickle cell disease

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