Pregnancy Outcomes Among Women With Sickle Cell Disease in Bahrain: A Case-Control Study.

Abstract

Objectives The study sought to evaluate and compare the maternal and fetal outcomes of pregnancy in women with sickle cell disease (SCD) versus healthy pregnant women in Bahrain. The objective was to update the available data in order to come up with a strategy to implement a multidisciplinary management program, which will enhance pregnancy outcomes for the SCD patient population. Materials and methods This retrospective case-control study was conducted in the Obstetrics and Gynecology Department at Salmaniya Medical Complex (SMC) in Bahrain. The study group consisted of all pregnant women with homozygous SCD (HbSS) who delivered at SMC between January 1, 2019, and December 31, 2021. The control group comprised pregnant women who delivered at SMC during the same period but did not have SCD or trait. Data for the study were collected from the healthcare system records at SMC, specifically the I-Seha electronic medical record system and the labor room registry book. A thorough review and analysis of the data were conducted, encompassing 217 cases of SCD and 200 controls. The variables examined included nationality, age, gravidity, parity, gestational age, reason for admission, antenatal/postnatal complications (such as urinary tract infection, pneumonia, acute chest syndrome, thromboembolism, premature rupture of membranes, hypertension, pre-eclampsia, and intrauterine growth restriction), type of delivery, birth weight, newborn outcome, and postnatal complications. Results Pregnant women with SCD experienced significantly higher rates of antenatal hospitalization compared to controls - 69.6% were admitted at least twice versus only 16.5%. Vaso-occlusive crises were the primary reason for admission in over half of SCD patients, with 22.6% having one episode, 11.1% having two, and 20.3% having more than two during pregnancy. Low hemoglobin levels also necessitated admission in 11.1% of SCD women, while no controls required hospitalization for this. The burden of maternal morbidity was substantially greater in the SCD group, with only 20.3% free of complications versus 94% in controls. SCD women had elevated rates of blood transfusions, acute chest syndrome, and urinary tract infections. Adverse pregnancy outcomes were also more common, including higher risks of preterm birth, low birth weight, and intrauterine growth restriction. Despite these increased maternal and fetal risks, there was no significant difference in the incidence of hypertensive disorders between groups. Interestingly, our data showed a significantly lower incidence of gestational diabetes in the SCD group compared to controls (8.3% vs. 18%). Tragically, one maternal death occurred in the SCD group, although the overall maternal mortality did not differ significantly. Conclusion SCD poses substantial risks for mother and fetus. Careful monitoring with a multidisciplinary team and patient education are crucial. Early detection can reduce morbidity and mortality. Further research is needed on interventions to improve outcomes.