Obstetric and Gynecological History in Sickle Cell Disease Females

Pregnancy in sickle cell disease (SCD) has been associated with complications and adverse outcomes for mother and child and thus warrants specialized clinical care. There is bidirectional impact between pregnancy and SCD. Only a small number of previous studies of pregnancy outcomes in SCD patients have been published, and some have been based on nationwide diagnosis queries rather than direct patient queries. An increased incidence of spontaneous abortion, pregnancy-induced hypertension, infections, pre-term labor, and low birth weight was noted in those reports. The aim of the present study was to identify and describe the characteristics and outcomes of pregnancy and other gynecological events in our current patients with SCD. We hypothesized that these women experience a higher frequency of pregnancy-related complications and earlier onset of menopause than the general population. One hundred adult female SCD patients from the Duke University Medical Center sickle cell clinic were included in this study. Sixty five were homozygous for hemoglobin (Hb) SS, 22 had Hb SC and 13 had other Hb genotypes. A standard questionnaire was developed, and patients were interviewed either personally or by telephone after obtaining IRB-approved informed consent. Most of the data reported here comes from patient interviews. Medical records were reviewed only to confirm Hb genotype and age. The mean age of individuals included in the study was 38.7± 13 years (range 19–75 yr). Sixty-seven of 100 reported a history of regular menses. The median age at menopause was 45 yr (range 27 to 58) as compared to 49.3 yr in the general African American population (AA) (Bromberger, Am J Epidemiol. 1997). Twenty-five percent of the patients were never pregnant, 92% of those (23 out of 25) stated they did so by choice. Seventy-five patients reported a total of 158 pregnancies; there were 111 live births and 3 still-births. One tubal pregnancy was terminated. Patients reported a total of 43 abortions: 28 were spontaneous, and 15 were induced. Twenty-seven (36%) patients have had at least one abortion. Of women with a history of pregnancy, 57 (76%) reported unplanned pregnancies. Mean gestational age was 35.9 ± 5 weeks. Maternal complications evaluated included: thrombosis in 6 patients (8%), five in the lower limb and one in the lungs; and pregnancy-induced hypertension in 10 (13%) patients. The rate of live births was 0.7. The prevalence of low birth weight was higher than in the AA population (26.3% vs. 13.2%, respectively) and the mean birth weight was lower than the AA population (2595.5 vs. 3089 g, respectively) (David et al, NEJM. 1997). The mean birth weight for women who increased their use of pain medications during pregnancy was lower than that for women who continued on the same pain medication regimen, those who took less medication, and those who did not use pain medication (2045, 2743, 2758, and 2924 g, respectively, p < 0.02). The babies of patients in the first group were more likely to stay longer in the hospital (p = 0.006). We conclude that obstetrical and gynecological outcomes in SCD patients differ significantly from and are in general worse than for the AA population, especially for menstrual history, onset of menopause, prevalence of low birth weight and mean birth weight. Moreover, increased use of pain medications in pregnancy was associated with lower birth weight. This finding is troublesome and deserves further study.