Fetomaternal outcomes in antenatal women with sickle cell hemoglobinopathies: an observational study from central India

Banishree Pati; Manas Ranjan Moharana; Prabha Sahu

doi:10.18203/2320-1770.ijrcog20252721

Authors

Banishree Pati Department of Obstetrics and Gynecology, Raipur Institute of Medical Sciences (RIMS), Raipur, Chhattisgarh, India
Manas Ranjan Moharana Department of Obstetrics and Gynecology, Raipur Institute of Medical Sciences (RIMS), Raipur, Chhattisgarh, India
Prabha Sahu Department of Obstetrics and Gynecology, Raipur Institute of Medical Sciences (RIMS), Raipur, Chhattisgarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20252721

Keywords:

Anemia, Chhattisgarh, Neonatal outcomes, Pregnancy, Sickle cell disease

Abstract

Background: Sickle cell hemoglobinopathies, especially prevalent in tribal populations of central India, pose significant obstetric and neonatal risks. Early recognition and high-risk pregnancy management are essential in minimizing complications. Objective was to analyze fetomaternal and labor outcomes in antenatal mothers with sickle cell hemoglobinopathies (SCD and SCT) attending a tertiary care center in Chhattisgarh.

Methods: A hospital-based prospective observational study was conducted at RIMS, Raipur, over 18 months. A total of 75 antenatal women in the third trimester diagnosed with sickle cell hemoglobinopathies were enrolled. Clinical data on maternal (anemia, PIH, ICU stay), fetal (birth weight, NICU admission, Apgar scores), and labor outcomes (gestational age, delivery mode) were collected and analyzed using SPSS v28.0.

Results: Out of 75 participants, 93.3% had sickle cell trait (HbAS) and 6.6% had sickle cell disease (HbSS). Anemia was present in 65.3% (mild in 40%, moderate in 18.7%, severe in 6.6%). PIH occurred in 13.3%, and 2.7% required ICU admission. No postpartum hemorrhage or maternal mortality was noted. LBW was observed in 45.3%, NICU admission in 17.3%, Apgar<7 at 1 minute in 18.7%. Cesarean section was performed in 77.3% of cases, and preterm birth occurred in 22.7%.

Conclusions: Sickle cell hemoglobinopathies are associated with a high burden of maternal anemia, hypertensive disorders, and adverse neonatal outcomes. Enhanced antenatal surveillance, multidisciplinary care, and community-based screening are recommended to improve outcomes in high-prevalence regions.

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References

Piel FB, Steinberg MH, Rees DC. Sickle cell disease. N Engl J Med. 2017;376(16):1561-73. DOI: https://doi.org/10.1056/NEJMra1510865

Desai G, Anand A, Shah P, Shah S, Dave K, Bhatt H, et al. Sickle cell disease and pregnancy outcomes: a study of the community-based hospital in a tribal block of Gujarat, India. J Health Popul Nutr. 2017;36(1):3. DOI: https://doi.org/10.1186/s41043-017-0079-z

Saraf SL, Molokie RE, Nouraie M, Sable CA, Luchtman-Jones L, Ensing GJ, et al. Differences in the clinical and genotypic presentation of sickle cell disease around the world. Paediatr Respir Rev. 2014;15(1):4-12. DOI: https://doi.org/10.1016/j.prrv.2013.11.003

Al-Azri MH, Al-Belushi R, Al-Mamari M, Davidson R, Mathew AC. Knowledge and health beliefs regarding sickle cell disease among Omanis in a primary healthcare setting: cross-sectional study. Sultan Qaboos Univ Med J. 2016;16(4):e437-44. DOI: https://doi.org/10.18295/squmj.2016.16.04.006

Mohanty D, Mukherjee MB, Colah R. Sickle cell disease in tribal populations in India. Indian J Med Res. 2011;134(3):294-301.

World Health Organization. Sickle-cell anaemia: Report by the Secretariat. Report No.: A59/9. Geneva: WHO; 2006.

Oteng-Ntim E, Meeks D, Seed PT, Webster L, Howard J, Doyle P, et al. Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis. Blood. 2015;125(21):3316-25. DOI: https://doi.org/10.1182/blood-2014-11-607317

Villers MS, Jamison MG, De Castro LM, James AH. Morbidity associated with sickle cell disease in pregnancy. Am J Obstet Gynecol. 2008;199(2):125.e1-5. DOI: https://doi.org/10.1016/j.ajog.2008.04.016

Jain D, Bagde MN, Deshmukh P, Bhatnagar N. Pregnancy in sickle cell hemoglobinopathies: maternal and perinatal outcome. J Obstet Gynecol India. 2019;69(3):218-24.

D’Couth S, Cacodcar JA, Naik J, Mangeshikar P. Maternal and fetal outcomes in pregnancies complicated by sickle cell disease. Int J Reprod Contracept Obstet Gynecol. 2017;6(9):3911-5.

Desai G, Naik D, Shrivastava P, Desai S. Pregnancy outcomes among tribal women with sickle cell disorders in Gujarat, India. J Obstet Gynecol India. 2017;67(3):163-8.

Aghamolaei T, Tabrizi R, Asadian F, Yousefzadeh G, Rezaei S, Mirzaei M, et al. Fetomaternal outcomes in pregnancies complicated by sickle cell disease: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2022;22(1):456.

Basu S, Ranjan R, Kumar A. The impact of proteinuria on maternal and fetal outcomes in pregnant women with sickle cell disease. Int J Gynecol Obstet. 2018;143(2):197-203.

Sharma D, Shastri S, Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clin Med Insights Pediatr. 2016;10:67-83. DOI: https://doi.org/10.4137/CMPed.S40070

Ganesh B, Varghese A, Narayanappa D. Maternal and perinatal outcomes of sickle cell disease in Indian tribal populations: a review. J Fam Med Prim Care. 2021;10(6):2347-54.

Rajauria S, Suryawanshi M, Khandelwal A, Rajurkar N, Wankhede S. Fetomaternal outcomes in sickle cell hemoglobinopathy pregnancies: a retrospective cohort study in Maharashtra. Cureus. 2023;15(5):e38021.

Rey A, Stoll BJ, Mendez-Figueroa H. Sickle cell disease and pregnancy: Maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, 2018;219(5):487.e1-8.

SMFM Publications Committee. Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell disease in pregnancy. Am J Obstet Gynecol. 2021;224(2):B2-13.

Fernandes F, Braga JA. Sickle cell disease in pregnancy. Rev Bras Hematol Hemoter. 2015;37(4):245-6.

Olayemi E, Fawole AO. Experience with low-dose aspirin in the prevention of hypertensive disorders in Nigerian pregnant women with sickle cell disease. Afr J Reprod Health. 2008;12(3):153-60.

Yadav SP, Jain N, Jain S. Sickle cell disease in pregnancy: a review. J Postgrad Gynecol Obstet. 2017;4(12):e1-6.

Nnodu OE, Sopekan A, Ohagwu K, Adegoke SA, Abjah U. Guidelines for the management of sickle cell disease in pregnancy. Federal Ministry of Health Nigeria. 2014.

Agarwal S, Stanek JR, Vesely SK, Creary SE, Cronin RM, Roe AH, et al. Pregnancy related thromboembolism in women with sickle cell disease:an analysis of National Medicated Data. Am J Hematol. 2023;98(11):1677-84. DOI: https://doi.org/10.1002/ajh.27045

Patel R, Marbaniang SP, Srivastava S, Kumar P, Chauhan S, Dwivedi LK. Why women choose to deliver at home in India: a study of prevalence, factors, and socio-economic inequality. BMC Public Health. 2021;21(1):1785. DOI: https://doi.org/10.1186/s12889-021-11779-5

Mohanty S, Srivastava A, Mohanty SK. Maternal complications following facility and home deliveries: Findings from India. BMC Health Serv Res. 2015;15:267.