PREGNANCY IN SICKLE-CELL DISEASE - EXPERIENCE OF THE COOPERATIVE STUDY OF SICKLE-CELL DISEASE

Objective: To determine the maternal and fetal outcomes of pregnancy i n women with sickle cell disease. Methods: The subjects were part of a cohort recruited from 19 centers for a prospective study of the clini cal course of sickle cell disease. Each participant was evaluated usin g a structured protocol in which steady-state data and information on both sickle- and non-sickle-related events were collected. The rates o f antepartum and intrapartum complications were tallied for pregnancie s carried to delivery. Fetal outcome was assessed according to gestati onal age, birth weight, and Apgar score. Differences among genotypes i n event rates were assessed using Fisher exact test. Differences in ge stational age and birth weight, and predictors of these outcomes, were assessed using analyses of covariance. Results: Two hundred eighty-si x of the 445 reported pregnancies proceeded to delivery. Non-sickle-re lated antepartum and intrapartum complication rates were comparable wi th those of African-American women who did not have sickle cell diseas e. One of the two deaths observed during this study was directly relat ed to the presence of sickle cell disease. Rates of maternal morbidity from sickle cell disease were the same during pregnancy as during the nonpregnant state. Ninety-nine percent of those pregnancies carried t o delivery resulted in a live birth. Twenty-one percent of the infants born to women of the SS genotype were small for gestational age (SGA) . Preeclampsia and acute anemic events were identified as risk factors for SGA infants. Conclusion: Those caring for women with sickle cell disease should support them if they desire to have children.