Pregnancy Outcomes among Antenatal Women with Sickle Cell Anaemia: A Case Series

Abstract

Sickle Cell Anaemia (SCA) is a common and severe form of an inherited blood disorder known as Sickle Cell Disease (SCD). SCD is a group of autosomal recessive disorders characterised by point mutation resulting in the formation of structurally defective haemoglobin (Hb), called haemoglobin S (HbS). SCD is clinically heterogeneous, with variability in manifestation ranging from being asymptomatic to a severe crisis that can be fatal. Pregnancies complicated by SCA are high-risk due to the disease's heterogeneous manifestations and propensity for maternal and foetal complications. This case series aimed to understand associated maternal and foetal outcomes at a tertiary care hospital. Women presented with a spectrum of clinical presentations from uncomplicated deliveries to cases involving severe acute and chronic sequelae. Preterm birth before 37 weeks, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions were common, reflecting known risks of growth restriction and prematurity. Previous adverse outcomes such as stillbirth and spontaneous abortion highlighted the threat to maternal and perinatal mortality. Acute sickle cell crises and splenic sequestration occurred. Advanced maternal age and comorbidities such as asthma exacerbated the disease burden. Most of the participants suffered from recurrent adverse outcomes with subsequent gestations. As most of the participants belonged to backward communities, targeted screening could help with earlier identification and counselling to reduce disease incidence in vulnerable populations.