Maternal Delivery Outcomes Associated With Acute Sickle Cell Crisis: A National Inpatient Analysis

Pregnancies complicated by sickle cell disease (SCD) carry substantial maternal and perinatal risk, but the specific association between acute sickle cell crisis (SCC) and adverse obstetric outcomes at delivery remains incompletely characterized. This study evaluated whether acute sickle cell crisis was associated with hypertensive disorders of pregnancy and cesarean delivery among delivery hospitalizations involving SCD.

We performed a retrospective cross-sectional analysis of the 2021 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). Delivery hospitalizations involving SCD were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and classified as involving acute sickle cell crisis or SCD without crisis. The primary outcome was a composite of severe preeclampsia, eclampsia, or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Secondary outcomes were any preeclampsia, eclampsia, or HELLP syndrome and cesarean delivery. Survey-weighted logistic regression estimated crude and adjusted odds ratios while accounting for the complex sampling design. Adjusted models included maternal age, Black versus non-Black race and ethnicity, and obesity.

The final cohort included 508 unweighted hospitalizations, representing an estimated 2,540 delivery hospitalizations nationally; 68 (13.4%) involved acute crisis, and 440 (86.6%) involved SCD without crisis. Percentages for study outcomes are survey-weighted, and n values are unweighted. Severe preeclampsia, eclampsia, or HELLP syndrome occurred in 19 (27.9%) hospitalizations involving acute crisis compared with 30 (6.8%) without crisis. Acute crisis was associated with higher adjusted odds of the primary outcome (adjusted odds ratio (aOR): 4.63; 95% confidence interval (CI): 2.43-8.85; p<0.001). The association remained significant after additional adjustment for gestational age (aOR: 4.27; 95% CI: 2.11-8.62; p<0.001). Acute crisis was also associated with any preeclampsia, eclampsia, or HELLP syndrome (aOR: 3.62; 95% CI: 1.96-6.71; p<0.001) and cesarean delivery (aOR: 2.18; 95% CI: 1.30-3.68; p=0.003).

Among delivery hospitalizations involving SCD, acute sickle cell crisis was strongly associated with severe hypertensive disorders of pregnancy and cesarean delivery. Acute crisis may identify a particularly high-risk clinical state during delivery hospitalization and may warrant close surveillance and coordinated multidisciplinary management.