Low Mortality and High Severe Maternal Morbidity in Pregnancy Among People With Sickle Cell Disease [A174

Abstract

INTRODUCTION: Pregnancy in people with sickle cell disease (SCD), who are predominantly Black, is high-risk. This study’s purpose is to update risk estimates of severe pregnancy outcomes in SCD and define the excess risk attributable to SCD. METHODS: We analyzed pregnancy-related admissions in the 2012–2018 National Inpatient Sample (NIS) and compared rates of the Center for Disease Control and Prevention’s Severe Maternal Morbidity (SMM) Index in SCD to the general unaffected population (GP) and the unaffected Black population (UB). The composite SMM excluded transfusion and vaso-occlusive crisis. Multivariate logistic regression was used to calculate odds ratios and excess risk fractions, controlling for age, multiple gestation, socioeconomic variables, and hospital characteristics. RESULTS: There were 8,121,002 pregnancy-related admissions, 6,610 among people with SCD (87% Black). There were few maternal deaths in SCD pregnancies (<10). SCD pregnancies were over three times as likely to experience SMM than GP or UB pregnancies (GP: OR 4.63, 95% CI 4.16–5.16, P<.001; UB: OR 3.33, 95% CI 2.97–3.75, P<.001). SCD pregnancies had higher odds of hysterectomy (GP: OR 2.24, P=.002; UB: OR 1.68, P=.09), sepsis (GP: OR 6.72, P<.001; UB: OR 5.54, P<.001), venous thromboembolism (GP: OR 9.89, P<.001; UB: OR 6.24, P<.001), and cerebrovascular event (GP: OR 13.94, P<.001; UB: OR 10.90, P<.001). In SCD pregnancies, excess risk for composite SMM was attributable to SCD status (70%; 95% CI, 67–73%), Black race (31%; 95% CI, 30–32%), and public insurance (14%; 95% CI, 14–15%). CONCLUSION: Contemporary data identifies SMM-, race-, and insurance-based disparities in SCD pregnancies, highlighting the need for disease-specific, pharmacotherapeutic interventions during pregnancy, and requires further prospective validation.