The presence of sickle cell disease (SCD) contributed to disparities in severe maternal morbidities (SMM), regardless of the need for blood transfusion during delivery hospitalization, in a large retrospective study.

The greatest increase in risk from SCD included thrombotic embolism puerperal cerebrovascular disorders, and blood transfusion.

The retrospective, population-based study, which was published in JAMA Pediatrics, analyzed data from 8,693,616 patients with or without SCD in 5 states who had a live or stillborn birth between 2008 and 2020. The primary outcome was SMM, including or excluding blood transfusion.

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The median age of the entire population was 28.5, and 11.0% of patients were Black. Of the Black patients, 0.37% had SCD. Medicaid insurance and cesarean delivery were more common among Black patients. The SMM comorbidity index score with transfusion was a median of 13 and 3 among women with or without SCD, and the SMM comorbidity index without a transfusion was a median of 3 and 11, respectively.

The disparity between Black and White women for SMM was attributable to SCD in 8.9% of cases, and in 14.3% of cases for nontransfusion SMM. The rates of complications due to SCD were 0.37% among Black women, but SCD contributed to 4.3% and 6.9% of SMM including or excluding transfusions, respectively.

Among Black patients, SCD was significantly associated with an increased risk SMM (adjusted risk ratio [aRR], 3.8; 95% CI, 3.3-4.5) and nontransfusion SMM (aRR, 6.5; 95% CI, 5.3-8.0) during delivery hospitalization.

SCD also increased the risk of SMM at any time during pregnancy through 42 days postpartum (aRR, 4.7; 95% CI, 4.2-5.3) or 365 days (aRR, 4.7; 95% CI, 4.3-5.2) postpartum, 42 hours (aRR, 8.3; 95% CI, 7.3-9.5) or 365 days (aRR, 12.3; 95% CI, 11.4-13.3).

SCD was associated with an increased risk of hospital readmission within 42 days (aRR, 2.8; 95% CI, 2.5-3.1) and 365 days (aRR, 3.3; 95% CI, 3.1-3.5) postpartum. The SMMs with the greatest increased in risk with SCD included thrombotic embolism (aRR, 4.8; 95% CI, 2.9-7.8), puerperal cerebrovascular disorders (aRR, 4.7; 95% CI, 3.0-7.4), and blood transfusions (aRR, 3.7; 95% CI, 3.2-4.3).

“These findings suggest that SCD may be an important contributor to racial disparities in SMM and to SMM among Black patients; thus, new interventions for individuals with SCD are urgently needed,” the authors concluded in their report.

Boghossian NS, Greenberg LT, Saade GR, et al. Association of sickle cell disease with racial disparities and severe maternal morbidities in Black individuals. JAMA Pediatr. Published online June 5, 2023. doi: 10.1001/jamapediatrics.2023.1580