English abstract
Background
Pregnancies with Sickle cell anemia (SCA) and Sickle cell disease (SCD) are associated with high
maternal and fetal mortality. Moreover, it is associated with adverse pregnancy, fetal and neonatal
complications including Pre-eclampsia/eclampsia, Pregnancy Induced Hypertension (PIH),
anemia, preterm labor, vaso-occlusive crisis, fetal hypoxia, low birth weight (LBW), prematurity,
intrauterine growth retardation (IUGR), low APGAR and Neonatal Intensive Care Unit (NICU)
admission. Although, advancements have been noted in the management of these pregnancies,
pregnancy with SCD is still accompanied with increased maternal and neonatal outcomes despite
these advances.
Objective
The study aimed to explore the adverse pregnancy, fetal and neonatal outcomes among women
with sickle cell disease compared to non-SCD women.
Methods
A retrospective matched case-control study compared 171 pregnancies with sickle cell disease to
171 non-sickle cell disease pregnancies in Muscat. The data was retrieved from electronic medical
records and delivery registry book between Jan 2015 to August 2021. Deliveries <24 weeks or >
41weeks of gestation were excluded. Outcomes of interest included preterm labor, pre-eclampsia/
eclampsia, pregnancy induced hypertension, severe anemia, intrauterine growth retardation, fetal
distress, neonatal intensive care unit admission of neonates, low birth weight, and Low APGAR
score.
Results
Sickle cell disease women with severe anemia have increased odds of (x2=58.56, p<0.001) getting
adverse pregnancy outcomes than women without anemia. Sickle cell disease mothers had 21.97
% higher odds of getting an intrauterine growth retardation baby than non-sickle cell disease
mothers (x2=17.80, UOR= 2.91-166.13, p<0.001). Newborns born to Sickle cell disease mothers
had 3.93 % greater odds of being admitted to Neonatal intensive care unit than newborns born to
non-sickle cell disease mothers (x2=16.80, UOR= 1.97-7.84, p<0.001). Additionally, the children
born to sickle cell disease mothers had 10.90 % higher odds of being born with low birth weight
than children born to non-sickle cell disease mothers (x2=56.92, UOR= 5.36-22.16, p<0.001).
Hemoglobin level (OR= 0.17, p<0.001, 95% CI 0.10-3.0), past medical history (OR=7.95, 7 p<0.001, 95% CI 2.39-26.43), past surgical history (OR=17.69, p<0.001, 95% CI 3.41-91.76), and
preterm delivery (OR=9.48, p=0.005, 95% CI 1.95-46.23) were identified as predictors of adverse
pregnancy, fetal and neonatal outcomes.
Conclusion
Pregnant women with sickle cell disease are at increased risk for pregnancy, fetal, newborn adverse
outcomes compared to non- sickle cell disease mothers. Low rates of fetal mortality rate may
reflect improved antenatal surveillance and management in Oman.
