Postpartum Tubal Sterilization in Sickle Cell Disease in the 2012-2019 National Inpatient Sample

Background: Sickle cell disease (SCD) is associated with high-risk pregnancy and low rates of hormonal contraception use. Intersectional vulnerabilities among individuals with SCD in the United States raise historically and socially contingent questions about tubal sterilization (TS), yet immediate postpartum TS rates among individuals with SCD remain unknown. Methods: Using the 2012-2019 National Inpatient Sample, we conducted a repeated cross-sectional study to estimate the rate of TS among delivery hospitalizations for people with SCD, without SCD (non-SCD), Black people with and without SCD, and people with cystic fibrosis (CF). Logistic regression models estimated the adjusted odds of TS between SCD and comparison groups. Interaction analyses examined whether severe maternal morbidity (SMM) modified the association between TS and SCD. Results: After adjusting for patient and hospital characteristics, SCD had higher odds of TS compared with non-SCD deliveries (adjusted odds ratio [aOR] = 1.38 [1.06, 1.79]). Among deliveries coded with Black race, SCD deliveries had higher odds of TS than non-SCD deliveries (aOR = 1.42 [1.06, 1.90]). There was no difference in the odds of TS between SCD and CF deliveries (aOR = 1.0 [0.51, 2.24]). SMM more than doubled the odds of TS in SCD deliveries (interaction: aOR = 2.34 [1.57, 3.47]; aOR = 2.14 [1.40, 3.24] in Black race deliveries). Conclusion: Even after accounting for patient and hospital characteristics, people with SCD have higher odds of immediate postpartum TS compared with comparison groups. Possibly, SMM severity, patient preference, or clinician recommendations inform this finding. SMM is three to seven times more common in SCD than non-SCD pregnancies and may be a modifiable risk factor for TS in SCD deliveries.