title: Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis.
abstract: A systematic review and meta-analysis of observational studies were conducted to quantify the association between sickle cell disease in pregnancy and adverse maternal and perinatal outcomes. Data sources (Medline, Embase, Maternity and Infant care, Cochrane, Web of Science, Popline) were searched for publications to June 2014. Eligibility criteria included observational studies reporting maternal and perinatal health outcomes in pregnant women with sickle cell disease against a comparative group of pregnant women without sickle cell disease. Twenty-one studies (including 26,349 women with sickle cell disease; 26,151,746 women without sickle cell disease) were eligible for inclusion. Pregnancies in women with HbSS genotype, compared with women without sickle cell disease, were at increased risk of maternal mortality (relative risk [RR], 5.98; 95% confidence interval [CI], 1.94-18.44), preeclampsia (RR, 2.43; 95% CI, 1.75-3.39), stillbirth (RR, 3.94; 95% CI, 2.60-5.96), preterm delivery (RR, 2.21; 95% CI, 1.47-3.31), and small for gestational age infants (RR, 3.72; 95% CI, 2.32-5.98). Meta-regression demonstrated that genotype (HbSS vs HbSC), low gross national income, and high study quality were associated with increased RRs. Despite advances in the management of sickle cell disease, obstetrics, and neonatal medicine, pregnancies complicated by the disease remain associated with increased risk of adverse maternal and perinatal outcomes.
authors: Women's Health Academic Centre, King's College London, London, United Kingdom; Women's Services, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
authors: Eugene
authors: E
authors: Oteng-Ntim
authors: Women's Health Academic Centre, King's College London, London, United Kingdom;
authors: Daveena
authors: D
authors: Meeks
authors: Women's Health Academic Centre, King's College London, London, United Kingdom;
authors: Paul T
authors: PT
authors: Seed
authors: Women's Health Academic Centre, King's College London, London, United Kingdom;
authors: Louise
authors: L
authors: Webster
authors: Department of Haematology, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom.
authors: Jo
authors: J
authors: Howard
authors: London School of Hygiene and Tropical Medicine, London, United Kingdom; and.
authors: Pat
authors: P
authors: Doyle
authors: Women's Health Academic Centre, King's College London, London, United Kingdom; Women's Services, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom;
authors: Lucy C
authors: http://orcid.org/0000-0001-6219-3379
authors: LC
authors: Chappell
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000209:etiology*; D011256:Pregnancy Outcome / Q000453:epidemiology