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Worse pregnancy outcomes found for Black SCD patients in new study

Black women in California with sickle cell disease (SCD) have worse pregnancy outcomes than do Black women in the state who don’t have the inherited blood disorder, a new study reported.

For pregnant Black women with SCD, the rates of both stillbirth and pregnancy-related complications are higher, the study found.

Even after accounting for age, insurance status, and other sociodemographic factors, Black SCD patients were still more likely to have worse pregnancy outcomes than those without SCD. The biggest risks were of sepsis — a life-threatening response to infection — and a blood clotting complication called venous thromboembolism.

“Our results highlight the importance of multidisciplinary perinatal care, ongoing studies to target SCD modification, and increased public health efforts to reduce disparities in pregnancy-related outcomes for women with SCD,” the researchers wrote.

The study, “Pregnancy outcomes in women with sickle cell disease in California,” was published in the American Journal of Hematology.

Investigating pregnancy outcomes for Black women in California
Pregnancy imposes intense physical and physiological demands on the body. Underlying health conditions, such as SCD, can increase the risks of pregnancy-related complications.

Both historical data and more recent studies show that women with SCD have a higher risk of pregnancy-related complications and death compared with the general population.  

Since the more recent studies used data from 2012 to 2018, a research team in California now decided to analyze almost 30 years of administrative data from the state to more comprehensively assess pregnancy outcomes in SCD.

Importantly, because pregnancy complications are more frequent among Black people than in the general population in the U.S., the team used only data from Black SCD patients and Black women without the disorder in their study.

By limiting study groups in this way, the analyses could better focus on the effects of SCD and “account for any unmeasured social determinants of health associated with disparately poor maternal outcomes in Black women in the U.S.,” the researchers wrote.

The team identified 1,260 Black women with SCD, ages 10-45, who gave birth at least once from 1991 to 2019. Pregnancy outcomes in these women were compared with those of 469,018 Black women without SCD of similar age who also had at least one birth over the same period of time.

In the Black SCD patients, pregnancy led to a significant increase in hospitalizations for acute vaso-occlusive crisis (VOC) and pneumonia or acute chest syndrome (a serious lung complication) compared with the frequency before pregnancy. The risk of acute episodes was found to increase with gestation time.

Compared with Black women without SCD, Black SCD patients were younger at delivery and had more co-existing conditions, or comorbidities. They also were more likely to use government insurance and live in low-income areas.

Pregnant Black women with SCD also were more likely to give birth via cesarean section.

Black SCD patients had significantly higher rates of stillbirth, maternal death — during pregnancy or at or right after delivery — and pregnancy-related complications during the time surrounding delivery, called peripartum, than those without SCD. The exception in worse outcomes was for gestational diabetes.

The disproportionately prevalent complications in SCD patients included preterm delivery, postpartum hemorrhage (uncontrolled bleeding after birth), venous thromboembolism, sepsis, and an onset or worsening of high blood pressure, called preeclampsia.

The rates of these complications remained significantly higher in Black SCD patients after accounting for age, number of coexisting conditions, and socioeconomic factors of the individuals, particularly sepsis and venous thromboembolism.

Further, the risk of sepsis and venous thromboembolism significantly increased as the delivery date approached and for a few days afterward in SCD patients, while it remained steady and low in those without SCD. The risk of postpartum hemorrhage for SCD patients also increased in the days after delivery.

The research team suggested that this increased risk of venous thromboembolism and sepsis might be caused by physiological changes during pregnancy that can exacerbate the SCD-related blood complications and sensitivity to infection.

“Despite advances in SCD and obstetrical care in the [U.S.], these results show worse peripartum outcomes in Black women with SCD, even after accounting for relevant clinical and sociodemographic factors,” the researchers wrote.

The team stressed, however, that most pregnancies in people with SCD result in live births, and that these findings should not discourage women with SCD from pregnancy. They also noted that more studies are needed to find how best to manage and care for pregnancy in people with SCD.

“Our data emphasize the need for integrating reproductive health counseling into the care of girls and women with SCD, so they can make informed reproductive decisions,” the researchers concluded.

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