Effect of active prenatal management on pregnancy outcome in sickle cell disease in an African setting

Sickle cell disease (SCD) is associated with an increased risk of medical c omplications during pregnancy. In sub-Saharan Africa, fetal and maternal mo rtality rates are particularly high. This study evaluated the effect of an active prenatal management program on pregnancy outcome in patients with SC D in an African setting. Pregnant women with SCD attending the National Tea ching Hospital in Cotonou (The Republic of Benin, West Africa) were recruit ed before the 28th week of gestation. Management was based on providing inf ormation and education about SCD and improving nutritional status, malaria prevention, early detection of bacterial infections, and restricted use of blood transfusion, Maternal and fetal mortality rates and SCD-related morbi dity were the principal variables assessed. One hundred and eight patients (42 SS and 66 SC) with 111 fetuses were included in the study, Thirteen fet al deaths (from 9 SS and 4 SC mothers) were recorded and 2 deaths of SC mot hers. The maternal mortality rate of 1.8% was comparable with the overall m aternal mortality rate for this maternity unit (1.2%), Few SCD-related even ts were recorded. Plasmodium falciparum malaria infection was the major cau se of morbidity, Sixty-three patients (19 SS and 44 SC) successfully comple ted their pregnancy (58.3%) without requiring transfusion. Providing pregna nt SCD patients with relevant medical care based on simple cost-effective a pproaches can have a positive impact on SCD-associated morbidity and mortal ity in an otherwise difficult setting in Africa, (C) 2000 by The American S ociety of Hematology.