Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy – a balance of risks for aspirin?

Shanea M.P. Gibson, Tiffany A. Hunter, Phillip E. Charles, Melonie A.C. Morgan, Shari K.R. Griffith-Anderson, J. Kennedy Cruickshank, Maxine D. Gossell-Williams, Nadine a. Johnson

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Sickle cell disease (SCD) occurs in 2.8% of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. Methods: A retrospective comparative analysis of HbSS, HbSC and HbSβThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. Results: Of 120 patients (138 pregnancies), obesity occurred in 36 % (20/56) of the 'non-HbSS' group, i.e. HbSβThal (55 %, 5/9) and HbSC (32 %, 15/47) combined vs. 9.7 % of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal 'near-misses' (OR=10.7, 95 % 3.5-32.3; p<0.001), hospitalizations (OR 7.6, 95 % CI 3.4-16.9; p<0.001), low birth weight (LBW) neonates (OR 3.1, 1.1-8.9; p=0.037) and preterm birth (OR=2.6, 1.2-5.8; p=0.018) compared to HbSC and HbSβThal. Low dose aspirin was prescribed in 43 %. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2 %), were LESS likely to have a live birth (75 v. 95 % (0.2, 0.04-0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46 % (0.5, 0.03-0.9, p=0.03)). Conclusions: HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.

Original languageEnglish
Pages (from-to)485-493
Number of pages9
JournalJournal of Perinatal Medicine
Volume52
Issue number5
DOIs
Publication statusPublished - 1 Jun 2024

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