title: Sickle cell disease and pregnancy outcomes: a study of the community-based hospital in a tribal block of Gujarat, India.
abstract: Sickle cell disease (SCD) is a hereditary blood disorder prevalent in tribal regions of India. SCD can increase complications during pregnancy and in turn negatively influence pregnancy outcomes. This study reports the analysis of tribal maternal admissions in the community-based hospital of SEWA Rural (Kasturba Maternity Hospital) in Jhagadia block, Gujarat. The objective of the study is to compare the pregnancy outcomes among SCD, sickle cell trait and non-SCD admissions. This study also estimated the risk of adverse pregnancy outcomes for SCD admissions.
  
  
  
  The data pertains to four and half years from March 2011 to September 2015. The total tribal maternal admissions were 14640, out of which 10519 admissions were deliveries. The admissions were classified as sickle cell disease, sickle cell trait and non-sickle cell disease. The selected pregnancy outcomes and maternal complications were abortion, stillbirth, Caesarean section, haemoglobin levels, blood transfusion, preterm pregnancy, newborn birth weight and other diagnosed morbidities (IUGR, PIH, eclampsia, preterm labour pain). The odds ratios for each risk factor were estimated for sickle cell patients. The odds ratios were adjusted for the respective years.
  
  
  
  Overall, 1.2% (131 out of 10519) of tribal delivery admissions was sickle cell admissions. Another 15.6% (1645 out of 10519) of tribal delivery admissions have sickle cell trait. The percentage of stillbirth was 9.9% among sickle cell delivery admission compared to 4.2% among non-sickle cell deliveries admissions. Among sickle cell deliveries, 70.2% were low birth weight compared to 43.8% of non-sickle cell patient. Similarly, almost half of the sickle cell deliveries needed the blood transfusion. The 45.0% of sickle cell delivery admissions were pre-term births, compared to 17.3% in non-SCD deliveries. The odds ratio of severe anaemia, stillbirth, blood transfusion, Caesarean section, and low birth weight was significantly higher for sickle cell admissions compared to non-sickle cell admissions.
  
  
  
  The study exhibited that there is a high risk of adverse pregnancy outcomes for women with SCD. It may also be associated with the poor maternal and neonatal health in these tribal regions. Thus, the study advocates the need for better management of SCD in tribal Gujarat.
authors.affiliation: Kasturba Maternity Hospital, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Gayatri
authors.initials: G
authors.lastname: Desai
authors.affiliation: Community Health Project, SEWA Rural, Bharuch, Gujarat, India. ankit.anand189@gmail.com.|Population Research Centre, Institute for Social and Economic Change, Bangalore, India. ankit.anand189@gmail.com.
authors.forename: Ankit
authors.identifier: 0000-0003-2454-0696
authors.initials: A
authors.lastname: Anand
authors.affiliation: Kasturba Maternity Hospital, SEWA Rural, Bharuch, Gujarat, India.|Community Health Project, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Shah
authors.affiliation: Women's Health and Training, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Shobha
authors.initials: S
authors.lastname: Shah
authors.affiliation: Community Health Project, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Kapilkumar
authors.initials: K
authors.lastname: Dave
authors.affiliation: Community Health Project, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Hardik
authors.initials: H
authors.lastname: Bhatt
authors.affiliation: Community Health Project, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Shrey
authors.initials: S
authors.lastname: Desai
authors.affiliation: Community Health Project, SEWA Rural, Bharuch, Gujarat, India.
authors.forename: Dhiren
authors.initials: D
authors.lastname: Modi
mesh_terms: D000028:Abortion, Induced; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000453:epidemiology; D001724:Birth Weight; D001803:Blood Transfusion; D002585:Cesarean Section; D005006:Ethnicity; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007194:India / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D047928:Premature Birth; D015995:Prevalence; D012805:Sickle Cell Trait / Q000150:complications / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology
keywords: Gujarat; Maternal health; Pregnancy outcomes; Sickle cell disease; Tribal