title: Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis.
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.
  
  
  OBJECTIVE
  We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with SCD.
  
  
  METHODS
  The MEDLINE database was searched using medical subject headings (MeSH) and keywords for articles on pregnancy outcomes in women with SCD.
  
  
  METHODS
  We used full research articles published in English that compared women with SCD with women who did not have SCD, as controls.
  
  
  METHODS
  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).
  
  
  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).
  
  
  CONCLUSIONS
  Pregnancy in women with SCD is associated with increased risks of adverse perinatal and maternal outcomes in both low- and high-income countries.
  
  
  CONCLUSIONS
  This meta-analysis showed worse pregnancy outcomes in women with sickle-cell disease compared with controls.
authors.affiliation: Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana.
authors.forename: T K
authors.initials: TK
authors.lastname: Boafor
authors.affiliation: Department of Haematology, University of Ghana Medical School, Accra, Ghana.
authors.forename: E
authors.initials: E
authors.lastname: Olayemi
authors.affiliation: Vanderbilt Center of Excellence in Sickle Cell Disease, Vanderbilt Children's Hospital and Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: N
authors.initials: N
authors.lastname: Galadanci
authors.affiliation: Department of Physiology, University of Ghana Medical School, Accra, Ghana.
authors.forename: C
authors.initials: C
authors.lastname: Hayfron-Benjamin
authors.affiliation: Department of Haematology, University of Ghana Medical School, Accra, Ghana.
authors.forename: Y
authors.initials: Y
authors.lastname: Dei-Adomakoh
authors.affiliation: Department of Child Health, University of Ghana Medical School, Accra, Ghana.
authors.forename: C
authors.initials: C
authors.lastname: Segbefia
authors.affiliation: Vanderbilt Center of Excellence in Sickle Cell Disease, Vanderbilt Children's Hospital and Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Kassim
authors.affiliation: Vanderbilt Center of Excellence in Sickle Cell Disease, Vanderbilt Children's Hospital and Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Aliyu
authors.affiliation: Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: H
authors.initials: H
authors.lastname: Galadanci
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Tuuli
authors.affiliation: Statistician, Chicago, IL, USA.
authors.forename: M
authors.initials: M
authors.lastname: Rodeghier
authors.affiliation: Vanderbilt Center of Excellence in Sickle Cell Disease, Vanderbilt Children's Hospital and Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.
authors.forename: S A
authors.initials: SA
authors.lastname: Oppong
mesh_terms: D000755:Anemia, Sickle Cell; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D014943:Global Health; D006801:Humans; D015233:Models, Statistical; D016017:Odds Ratio; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011256:Pregnancy Outcome
keywords: Maternal and perinatal outcome; pregnancy; sickle-cell disease