Risk factors for immediate postpartum sickle cell disease-specific maternal morbidity

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Maternal-Fetal Medicine

Background:

• Pregnant individuals with sickle cell disease (SCD) are at increased risk for postpartum complications.
• Immediate postpartum complications can significantly impact maternal morbidity.

Purpose of the Study:

• To assess the incidence and risk factors of immediate postpartum complications in pregnant individuals with SCD.
• To identify specific complications and patient characteristics associated with adverse outcomes.

Main Methods:

• Retrospective single-centre study of 201 pregnancies from 145 individuals between 2000 and 2018.
• Assessed a composite outcome of immediate postpartum complications including pain events, acute chest syndrome, infection, and hypoxia.
• Analyzed risk factors including SCD genotype, hypoxia during pregnancy, and mode of delivery.

Main Results:

• Immediate postpartum complications occurred in 37% of pregnancies, with vaso-occlusive pain events being the most common (97%).
• HbSS/HbSβ0 genotype was associated with a higher incidence of complications compared to HbSC/HbSβ+.
• Multivariable analysis identified hypoxia during pregnancy (OR 4.95) and unscheduled caesarean delivery (OR 2.67) as the strongest risk factors.

Conclusions:

• Hypoxia during pregnancy and unscheduled caesarean delivery are significant predictors of immediate postpartum complications in individuals with SCD.
• Future research should explore interventions to correct hypoxia and utilize predictive scores for scheduled caesarean deliveries to mitigate risks.