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Sickle Cell Disease in Pregnancy: Maternal Complications in a Medicaid-Enrolled Population

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Abstract

Higher frequencies of pregnancy complications have been reported among women with sickle cell disease (SCD) compared with those without SCD; however, past studies are limited by small sample size, narrow geographic area, and use of hospital discharge data. We compared the prevalence of maternal complications among intrapartum and postpartum women with SCD to those without SCD in a large, geographically diverse sample. Data from the 2004–2010 Truven Health MarketScan® Multi-State Medicaid databases were used to assess the prevalence of maternal complications among intrapartum and postpartum women 15–44 years of age with and without SCD whose race was reported as black. The comparison group of women without SCD was further divided into those with chronic conditions associated with multi-organ failure and those without chronic conditions. Multivariable log-binomial regression models were used to calculate adjusted prevalence ratios for outcomes for women with SCD compared with women in the two comparison groups. Of the 335,348 black women with a delivery during 2004–2010, 1,526 had a diagnosis of SCD (0.5 %). Compared with women without SCD who had chronic conditions, women with SCD had higher prevalence of deep vein thrombosis, pulmonary embolism, obstetric shock, pneumonia, sepsis, postpartum infection, and transfusions. SCD was also positively associated with acute renal failure, cerebrovascular disorder, respiratory distress syndrome, eclampsia, postpartum hemorrhage, preterm birth, and ventilation when compared with women without SCD and chronic conditions. Overall, women with SCD have increased prevalence of pregnancy complications, even when compared with a group of women with similar risk for multi-organ failure.

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Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-K34, 30341, Atlanta, Georgia

    Sheree L. Boulet

  2. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia

    Ekwutosi M. Okoroh, Ijeoma Azonobi, Althea Grant & W. Craig Hooper

Authors
  1. Sheree L. Boulet
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  2. Ekwutosi M. Okoroh
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  3. Ijeoma Azonobi
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  4. Althea Grant
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  5. W. Craig Hooper
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Corresponding author

Correspondence to Sheree L. Boulet.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Appendix

Appendix

See Table 4.

Table 4 ICD-9-CM codes for chronic conditions and maternal and obstetric complications and procedures
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Boulet, S.L., Okoroh, E.M., Azonobi, I. et al. Sickle Cell Disease in Pregnancy: Maternal Complications in a Medicaid-Enrolled Population. Matern Child Health J 17, 200–207 (2013). https://doi.org/10.1007/s10995-012-1216-3

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  • DOI: https://doi.org/10.1007/s10995-012-1216-3

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