Natural history of blood pressure in sickle cell disease pregnancy

Author:

Early Macy L.1,Luo Amy2,Solow Marissa34,Matusiak Kristine34,Eke Ahizechukwu C.56,Shehata Nadine7,August Phyllis8,Kuo Kevin H. M.34ORCID,Lanzkron Sophie1,Malinowski Ann Kinga91011,Pecker Lydia H.16ORCID

Affiliation:

1. Division of Hematology, Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA

2. Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA

3. Division of Haematology, Department of Medicine University Health Network Toronto Ontario Canada

4. Department of Medicine University of Toronto Toronto Ontario Canada

5. Division of Maternal‐Fetal Medicine & Clinical Pharmacology Baltimore Maryland USA

6. Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine Baltimore Maryland USA

7. Division of Hematology, Sinai Health System, Department of Medicine University of Toronto Toronto Ontario Canada

8. Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine New York New York USA

9. Division of Maternal‐Fetal Medicine Sinai Health System Toronto Ontario Canada

10. Department of Obstetrics and Gynecology University of Toronto Toronto Ontario Canada

11. Lunenfeld‐Tanenbaum Research Institute, Sinai Health System Toronto Ontario Canada

Abstract

SummaryIn this retrospective cohort study of singleton pregnancies in people with sickle cell disease (SCD) delivered at two academic centres between 1990 and 2021, we collected demographic and SCD‐related data, pregnancy outcomes, and the highest systolic and diastolic blood pressure (SBP and DBP) at seven time periods. We compared blood pressure values and trajectories in the composite cohort and in each genotype group to control values in a non‐SCD pregnancy dataset. There were 290 pregnancies among 197 patients with SCD. Sixteen per cent (n = 47) of pregnancies had a hypertensive disorder of pregnancy (HDP); the rates did not differ by genotype. The mean SBP and DBP were lower in the HbSS/HbSβ0 group than in the non‐SCD control group at all timepoints. Mean SBP and DBP trajectories were similar between the HbSS/HbSβ0 group and non‐SCD controls, whereas the mean SBP and DBP in the HbSC/HbSβ+ group decreased between the first and second trimesters and plateaued between the second and third trimesters. There were no differences in blood pressure trajectory by haemoglobin >/< 10 gm/dL or by chronic transfusion status. Overall, pregnant people with SCD have lower blood pressure than unaffected pregnant people, raising the possibility that HDP are underdiagnosed, particularly in people with HbSS/HbSβ0.

Funder

National Heart, Lung, and Blood Institute

Publisher

Wiley

Subject

Hematology

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