CLINICAL NEWS
Written in Blood
How Can We Better Predict
High-Risk Pregnancies for
Women with SCD?
Though sickle cell disease (SCD) is associated with significant lifetime
morbidity and premature mortality, better quality of care has led to improved survival, with more women reaching reproductive age. Pregnant
women with SCD, though, do experience an increased risk of maternal and
fetal adverse outcomes.
Given the lack of comprehensive data on pregnancy outcomes in these
women, quantifying that risk and identifying groups of women at the highest risk for poor outcomes has been challenging.
A new, first-of-its-kind meta-analysis reports that, when compared to
healthy pregnant women, pregnant women with a severe form of SCD are
six times more likely to die during or following pregnancy and have an
increased risk for stillbirth, high blood pressure, and preterm delivery.
The study, conducted by Eugene Oteng-Ntim, MD, and researchers
from King’s College London and the London School of Hygiene & Tropical
Medicine, examined 21 published observational studies comparing outcomes in women with and without SCD.
“While we know that women with sickle cell disease will have high-risk
pregnancies, we have lacked the evidence that would allow us to confidently tell these patients how likely they are to experience one complication
over another,” said Dr. Oteng-Ntim, MD. “This reality makes it difficult for
us as care providers to properly counsel our sickle cell patients considering
pregnancy.”
Taken together, the studies included 26,349 pregnant women with SCD
and 26,151,746 pregnant healthy women. Investigators classified the SCD
population based on genotype, including:
• 1,276 women with the classic form (HbSS genotype)
• 279 with a milder form (HbSC genotype)
• 24,794 whose disease genotype was unreported
Based on their analysis, in women with HbSS disease compared to
healthy women, there was an increased risk of:
• Maternal mortality (RR=5.98; 95% CI 1.94-18.44)
• Pre-eclampsia (RR=2.43; 95% CI 1.75-3.39)
• Eclampsia (RR=4.89; 95% CI 1.97-12.16)
• Stillbirth (RR=3.94; 95% CI 2.60-5.96)
• Neonatal death (RR=2.68; 95% CI 1.49-4.82)
• Preterm delivery (RR=2.21; 95% CI 1.47-3.31)
• Infants born small for gestational age (RR=3.72; 95% CI
2.32-5.98)
Thirteen of the studies Dr. Oteng-Ntim and investigators analyzed originated from high-income countries ($30,000 income per capita or greater), while the remaining were from low- to middle-income countries.
There was a substantial difference in the magnitude of risk of maternal
death and stillbirth for SCD patients from high-income countries, compared to those from low-income countries (OR=0.15; 95% CI 0.02-0.86
and OR=0.28; 95% CI 0.14-0.55, respectively). These results, the authors
wrote, “suggest that the risk of death is dependent on the availability of
adequate health-care resources and expertise.”
“In high-income countries, women with sickle cell disease are usually
managed by a multidisciplinary team of obstetricians, hematologists,
specialist midwives, and anesthetists, but the greatest burden of morbidity and mortality undoubtedly lies within low- and middle-income
countries where access to specialist antenatal care may be limited,” the
authors wrote.
ASHClinicalNews.org
Although women with milder or
unreported forms of SCD were less likely
than those with HbSS to experience complications, these women still remained
at higher risk for most complications
compared to healthy mothers. “Our report
suggests that, even in developed countries
with advanced care, there continues to be
a much higher maternal mortality rate in
women with sickle cell disease compared
to the general population, strongly suggesting that more work must be done to
improve outcomes for these patients and
their families,” said Dr. Oteng-Ntim. “By
improving care providers’ ability to more
accurately predict adverse outcomes, this
analysis is a first step toward improving
universal care for all who suffer from this
disease.” ●
Oteng-Ntim E, Meeks D, Seed PT, et al. Adverse maternal and perinatal
outcomes in pregnant women with sickle cell disease: systematic review
and meta-analysis. Blood. 2015 March 23. [Epub ahead of print]
Pregnant
women
with a
severe form
of SCD have
a six times
higher risk
of mortality
than healthy
mothers.
Entospletinib Makes Its Mark in
Chronic Lymphocytic Lymphoma
Therapies that target B-cell
receptor signaling kinases have
made great strides in chronic
lymphocytic lymphoma (CLL)
and other B-cell malignancies.
According to results from a phase
2 trial recently published in Blood,
entospletinib, a selective spleen
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