Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis

T K Boafor; E Olayemi; N Galadanci; C Hayfron-Benjamin; Y Dei-Adomakoh; C Segbefia; A A Kassim; M H Aliyu; H Galadanci; M G Tuuli; M Rodeghier; Michael R DeBaun; S A Oppong

doi:10.1111/1471-0528.13786

Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis

BJOG. 2016 Apr;123(5):691-8. doi: 10.1111/1471-0528.13786. Epub 2015 Dec 15.

Authors

T K Boafor¹, E Olayemi², N Galadanci³, C Hayfron-Benjamin⁴, Y Dei-Adomakoh², C Segbefia⁵, A A Kassim³, M H Aliyu³, H Galadanci⁶, M G Tuuli⁷, M Rodeghier⁸, Michael R DeBaun³, S A Oppong⁹

Affiliations

¹ Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana.
² Department of Haematology, University of Ghana Medical School, Accra, Ghana.
³ Vanderbilt Center of Excellence in Sickle Cell Disease, Vanderbilt Children's Hospital and Vanderbilt University School of Medicine, Nashville, TN, USA.
⁴ Department of Physiology, University of Ghana Medical School, Accra, Ghana.
⁵ Department of Child Health, University of Ghana Medical School, Accra, Ghana.
⁶ Aminu Kano Teaching Hospital, Kano, Nigeria.
⁷ Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO, USA.
⁸ Statistician, Chicago, IL, USA.
⁹ Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.

PMID: 26667608
DOI: 10.1111/1471-0528.13786

Abstract

Background: Pregnancy in women with sickle-cell disease (SCD) is associated with increased adverse outcomes. Findings on the association between SCD and adverse pregnancy outcomes are conflicting, and the results do not address whether these associations are similar in both low- and high-income countries.

Objectives: We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with SCD.

Search strategy: The MEDLINE database was searched using medical subject headings (MeSH) and keywords for articles on pregnancy outcomes in women with SCD.

Selection criteria: We used full research articles published in English that compared women with SCD with women who did not have SCD, as controls.

Data collection and analysis: Data were abstracted and analysed using comprehensive Meta-analysis 2.2. The primary outcomes were intrauterine growth restriction and perinatal mortality. Secondary outcomes were rates of caesarean sections, pre-eclampsia, eclampsia, postpartum haemorrhage, maternal mortality, prematurity, and low birthweight. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (95% CIs).

Main results: Sixteen studies met all of the selection criteria and were included in the analysis. SCD was associated with intrauterine growth restriction (pooled OR 2.79, 95% CI 1.85-4.21), perinatal mortality (pooled OR 3.76, 95% CI 2.34-6.06), and low birthweight (pooled OR 2.00, 95% CI 1.42-2.83). SCD was also associated with an increased risk of pre-eclampsia (pooled OR 2.05, 95% CI 1.47-2.85), maternal mortality (pooled OR 10.91, 95% CI 1.83-65.11, P = 0.009), and eclampsia (pooled OR 3.02, 95% CI 1.20-7.58).

Conclusion: Pregnancy in women with SCD is associated with increased risks of adverse perinatal and maternal outcomes in both low- and high-income countries.

Tweetable abstract: This meta-analysis showed worse pregnancy outcomes in women with sickle-cell disease compared with controls.

Keywords: Maternal and perinatal outcome; pregnancy; sickle-cell disease.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Anemia, Sickle Cell*
Developed Countries*
Developing Countries*
Female
Global Health
Humans
Models, Statistical
Odds Ratio
Pregnancy
Pregnancy Complications, Hematologic*
Pregnancy Outcome*