Implementation of a multidisciplinary treatment strategy may reduce maternal and perinatal mortality rates in women with sickle cell disease (SCD) in low-resource settings to comparable levels in women without SCD in the same setting, according to a study published in the American Journal of Hematology.
Researchers enrolled 266 pregnant women from the Korle-Bu Teaching Hospital (KBTH) in Ghana. In this population, 149 women had SCD (HbSS, 54; HbSC, 95), and 117 women had neither SCD nor sickle cell trait. The women were followed for 6 weeks after giving birth.
The team implemented a multidisciplinary care strategy that involved: collaboration between physicians from KBTH and from Vanderbilt University in Nashville, Tennessee; systematic literature reviews to highlight perinatal and maternal outcomes in pregnant women with SCD; assembling a treatment team comprising professionals from diverse clinical backgrounds, such as hematology, pediatrics, and laboratory science; and creating a clinical environment that expected, supported, and rewarded specific innovation.
The maternal mortality rates were 1.3% for women with SCD and 0.9% for women without SCD (P =1.00), and perinatal mortality rates were 7.4% and 3.4% (P =.164) for the same populations. For comparison, the maternal mortality death in African women with SCD is approximately 10%.
Women with SCD were more than twice as likely to have preeclampsia (12.3% vs 6.0%, P =.081) and be hospitalized for malaria (23.5% vs 11.8%, P =.022) compared with women without SCD. Women with SCD also had more preterm births (26.4% vs 16.2%, P =.048) and infants with low birthweight (25.2% vs 12.9%, P =.014). The number of cesarean deliveries was similar between the two groups (P =.193)
Among women with SCD, those who were HbSS had increased rates of perinatal morbidity and low birthweight. Additionally, 15% of newborns among women with SCD and sickle cell trait were found to have SCD, compared with the projected prevalence of 2% in this region.
Preeclampsia and low body mass index were both found to be risk factors for preterm birth and low birthweight among both cohorts.
Though the multidisciplinary care strategy had benefits, the authors cautioned that they were unable to identify which of the multiple interventions applied were most effective, and that their conclusions may not be generalizable to nontertiary care centers such as community hospitals without a hematologist.
1. Oppong SA, Asare EV, Olayemi E, et al. Multidisciplinary care results in similar maternal and perinatal mortality rates for women with and without SCD in a low-resource setting [published online November 19, 2018]. doi: 10.1002/ajh.25356