Postpartum outcomes in sickle cell disease: transfusion exposure, maternal morbidity, and breastfeeding persistence

To characterize postpartum maternal morbidity in women with sickle cell disease (SCD) and explore whether antepartum disease burden, transfusion exposure, and peripartum clinical factors were associated with postpartum maternal and breastfeeding outcomes.

We conducted a retrospective cohort study of 37 deliveries in patients with confirmed SCD at a large urban academic center (2015-2025). Maternal, neonatal, transfusion, and breastfeeding outcomes were abstracted from the electronic medical record.

Thirty-seven deliveries met inclusion criteria. The predominant genotype was HbSS (24/37, 64.9 %), followed by HbSC (7/37), HbSβ⁰-thalassemia (3/37), HbSβ⁺-thalassemia (2/37), and HbS/HPFH (1/37). More than one-third of deliveries (13/37, 35.1 %) required transfusion within the first postpartum week. Postpartum hemorrhage ≥1,000 mL occurred in 5 of 37 deliveries (13.5 %), and 5 of 36 (13.9 %) required readmission within 6 weeks postpartum, most commonly for vaso-occlusive crisis. NICU admission occurred in 14 of 37 neonates (37.8 %). Breastfeeding intention was high (32/33, 97 %); persistence declined to 23 of 33 (69.7 %) at 6 weeks and 12 of 34 (35.3 %) at approximately 6 months. Exploratory analyses suggested lower breastfeeding persistence among deliveries complicated by NICU admission and among those with greater antepartum clinical burden, including pregnancy transfusion, lower admission hemoglobin, and hospitalization during pregnancy.

The postpartum period in women with SCD is characterized by persistent hematologic morbidity, ongoing transfusion requirements, and declining breastfeeding persistence. Greater antepartum disease burden and neonatal complications may identify pregnancies at higher risk for adverse postpartum outcomes, supporting integrated hematology-obstetric care extending into the postpartum period.