The influence of maternal exchange transfusion on perinatal outcome in pregnant women with sickle cell disease

Abstract

IN PREGNANT WOMEN WITH SICKLE CELL DISEASE NAHLA KHALEK, JERRIE REFUERZO, NDAYA MULEBA, JANICE WHITTY, Wayne State University, Obstetrics and Gynecology, Detroit, Michigan OBJECTIVE: Pregnancies complicated with sickle cell disease (SCD) are at risk for perinatal morbidity including spontaneous preterm birth (SPB) and intrauterine growth restriction (IUGR). The benefits of antepartum exchange transfusion in mothers with severe disease to the infant post-natally are uncertain. The purpose of this study was to determine whether infants born to women with SCD who received exchange transfusions during pregnancy experienced a decrease in perinatal morbidity. STUDY DESIGN: A retrospective chart review including pregnant women with SCD and their neonates from 1997-2001 was performed. The rate of SPB as well as neonatal outcomes during the first week of life was compared between women who received exchange transfusions and those who did not. A composite morbidity was assessed during the neonatal period and included any of the following: IUGR, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) days, duration of antibiotic therapy, and number of days requiring oxygen or mechanical ventilation. Statistical analysis included Chi Square and Fisher’s Exact test. RESULTS: A total of 30 pregnant women with SCD were reviewed. 30% of women (9/30) received exchange transfusions during pregnancy. The rates of SPB, SGA and IUGR were similar between groups. Although not statistically significant, infants of mothers who received exchange transfusions during pregnancy had higher composite morbidity rates compared to those who did not (78.4% vs. 38.1%, P = .054). CONCLUSION: Pregnant women with SCD who require exchange transfusions during pregnancy may be at risk for increased neonatal morbidity. It is uncertain whether this is a direct effect of the exchange transfusion itself or the inherent consequence of birth from a high risk, complicated pregnancy. S100 SMFM Abstracts