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Outcome of pregnancy in homozygous sickle cell disease.
Obstet Gynecol. 2004 Jun; 103(6):1278-85.OG

Abstract

OBJECTIVE

Previous reports on pregnancy in homozygous sickle cell (SS) disease are biased by hospital-based, more severely affected subjects and may have underestimated recurrent early pregnancy losses. We report pregnancy outcome in a representative sample of SS subjects subsequently referred to as "subjects" or "sickle cell subjects," and matched normal controls followed from birth.

METHODS

The outcomes of 94 pregnancies in 52 subjects and 157 pregnancies in 68 controls followed in a cohort study from birth are presented. Outcome measures included the age at menarche, interval to first pregnancy, outcome of pregnancy, and maternal complications. Possible predictors of low birth weight are assessed. Outcomes were compared by the Kaplan-Meier analysis for interval to first pregnancy and by Student t test, chi(2) test, or Fisher exact test, as appropriate. Correction was made for multiple testing, and multiple linear regression was used for analysis of birth weight.

RESULTS

Compared with controls, SS subjects had later menarche (median age 15.4 versus 13.0 years) and first pregnancy (median age 23.7 versus 20.1 years), and more spontaneous abortions (36% versus 10%). Babies of SS subjects had a lower gestational age (P <.001) and lower birth weight (P <.001), the latter being significantly affected by sickle-related events in pregnancy. There was no difference in pregnancy-induced hypertension, preeclampsia, or antepartum or postpartum hemorrhage, but a retained placenta was marginally more common in SS subjects (Fisher exact test, P =.007 after adjustment for multiple testing). Two SS subjects died, a mortality rate of 2.1%.

CONCLUSION

The increased fetal loss and maternal morbidity in mothers with homozygous sickle cell disease is confirmed.

LEVEL OF EVIDENCE

II-2

Authors+Show Affiliations

Sickle Cell Trust (Jamaica) 14 Milverton Crescent, Kingston 6 , Jamaica, West Indies. grserjeant@cwjamaica.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15172865

Citation

Serjeant, Graham R., et al. "Outcome of Pregnancy in Homozygous Sickle Cell Disease." Obstetrics and Gynecology, vol. 103, no. 6, 2004, pp. 1278-85.
Serjeant GR, Loy LL, Crowther M, et al. Outcome of pregnancy in homozygous sickle cell disease. Obstet Gynecol. 2004;103(6):1278-85.
Serjeant, G. R., Loy, L. L., Crowther, M., Hambleton, I. R., & Thame, M. (2004). Outcome of pregnancy in homozygous sickle cell disease. Obstetrics and Gynecology, 103(6), 1278-85.
Serjeant GR, et al. Outcome of Pregnancy in Homozygous Sickle Cell Disease. Obstet Gynecol. 2004;103(6):1278-85. PubMed PMID: 15172865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of pregnancy in homozygous sickle cell disease. AU - Serjeant,Graham R, AU - Loy,Luana Look, AU - Crowther,Mark, AU - Hambleton,Ian R, AU - Thame,Minerva, PY - 2004/6/3/pubmed PY - 2004/7/3/medline PY - 2004/6/3/entrez SP - 1278 EP - 85 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 103 IS - 6 N2 - OBJECTIVE: Previous reports on pregnancy in homozygous sickle cell (SS) disease are biased by hospital-based, more severely affected subjects and may have underestimated recurrent early pregnancy losses. We report pregnancy outcome in a representative sample of SS subjects subsequently referred to as "subjects" or "sickle cell subjects," and matched normal controls followed from birth. METHODS: The outcomes of 94 pregnancies in 52 subjects and 157 pregnancies in 68 controls followed in a cohort study from birth are presented. Outcome measures included the age at menarche, interval to first pregnancy, outcome of pregnancy, and maternal complications. Possible predictors of low birth weight are assessed. Outcomes were compared by the Kaplan-Meier analysis for interval to first pregnancy and by Student t test, chi(2) test, or Fisher exact test, as appropriate. Correction was made for multiple testing, and multiple linear regression was used for analysis of birth weight. RESULTS: Compared with controls, SS subjects had later menarche (median age 15.4 versus 13.0 years) and first pregnancy (median age 23.7 versus 20.1 years), and more spontaneous abortions (36% versus 10%). Babies of SS subjects had a lower gestational age (P <.001) and lower birth weight (P <.001), the latter being significantly affected by sickle-related events in pregnancy. There was no difference in pregnancy-induced hypertension, preeclampsia, or antepartum or postpartum hemorrhage, but a retained placenta was marginally more common in SS subjects (Fisher exact test, P =.007 after adjustment for multiple testing). Two SS subjects died, a mortality rate of 2.1%. CONCLUSION: The increased fetal loss and maternal morbidity in mothers with homozygous sickle cell disease is confirmed. LEVEL OF EVIDENCE: II-2 SN - 0029-7844 UR - https://www.unboundmedicine.com/medline/citation/15172865/Outcome_of_pregnancy_in_homozygous_sickle_cell_disease_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=15172865.ui DB - PRIME DP - Unbound Medicine ER -