Pregnancy- and Disease-Related Morbidity Among Medicaid Enrollees With Sickle Cell Disease

Whereas pregnancy in sickle cell disease (SCD) is considered high risk, there is limited understanding of pregnancy- and SCD-related morbidity to inform clinical practice and health policy.

This retrospective cohort study aimed to describe pregnancy- and disease-related morbidity among individuals with SCD for up to 1 year postpartum using Medicaid claims (2010-2018) linked with newborn screening and clinical reports from four state Sickle Cell Data Collection programs. Medicaid enrollees aged 15-44 years with SCD were included. The most recent delivery hospitalization and associated complications were identified using the International Classification of Diseases nineth and tenth revisions. The main outcomes included pregnancy- and disease-related complications during pregnancy, at delivery, and up to 1 year post-delivery.

A total of 1286 individuals met the inclusion criteria (43% were 15-24 years old, 50% were 25-34 years old). Most (n = 957, 74%) were enrolled in Medicaid before pregnancy, 88% (n = 1132) were enrolled within their first 16 weeks of pregnancy, and 68% (n = 876) maintained Medicaid coverage for 1 year postpartum. High incidence of SCD-related morbidities including vaso-occlusive crisis (37.6%) and acute chest syndrome (5.8%), and obstetric complications-preeclampsia/eclampsia (9.6%), antepartum hemorrhage (24.2%), and preterm delivery (28.1%)-were reported through 60 days postpartum. Many individuals continued to have SCD-related complications beyond the 60-day postpartum period, including more than one-third having a vaso-occlusive crisis.

Individuals with SCD are at increased risk of pregnancy- and SCD-related morbidity throughout the perinatal period. Medicaid policies that ensure continuous coverage and encourage comprehensive multidisciplinary care models may reduce both SCD and obstetric complications and promote better maternal outcomes.