Abstract 9402: Venous Thromboembolism During Pregnancy is Associated with Elevated Tricuspid Regurgitation Velocity in Sickle Cell Disease

Abstract

Introduction: In patients with sickle cell disease (SCD), a tricuspid regurgitation velocity (TRV) > 2.5 m/s by echocardiogram is a non-invasive marker for underlying pulmonary hypertension (PH), and associated with increased mortality. During pregnancy, maternal and fetal adverse events are increased in women SCD, and in women with PH. Data on pregnancy outcomes in women with both SCD and elevated TRV are sparse; we hypothesized increased adverse events in this group. Methods: We retrospectively compared pregnancy outcomes in women with SCD and elevated TRV (>2.5 m/s) to those with SCD and normal TRV (≤ 2.5 m/s). Results: We identified 59 pregnancies in 43 women (mean age 28 ± 5 years at delivery) with SCD (31 pregnancies in women with elevated TRV, 28 with normal TRV). There was a trend towards more lifetime transfusions, and significantly lower hemoglobin in women with elevated TRV ( Figure A-B ). As expected, right ventricular systolic pressure was different between the groups, however other baseline characteristics, including SCD genotype, left ventricular systolic function, and pre-pregnancy venous thromboembolism (VTE) were similar ( Figure C-F ). No maternal deaths occurred in pregnancy or 1-year postpartum. VTE occurred in 7 (12%) pregnancies, only in women with elevated TRV; and postpartum readmission was more common in women with elevated TRV ( Figure G ). Other cardiac and hematologic outcomes occurred with similar incidence between the groups ( Figure G ). In viable pregnancies, preterm birth was more common in women with elevated TRV, while other adverse obstetric and fetal outcomes did not differ between the groups ( Figure G ). Conclusion: In conclusion, we identified a higher incidence of VTE, preterm birth and postpartum readmission in pregnant women with SCD and elevated TRV. These complications may be associated with worse SCD burden; however, the potential mechanistic link between pregnancy, VTE and PH as assessed by elevated TRV requires further study.