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Publication Type
Journal Article
UWI Author(s)
Author, Analytic
Serjeant, Graham R.; Luana, Look Loy; Crother, Mark; Hambleton, Ian R.; Thame, Minerva M.
Author Affiliation, Ana.
Tropical Medicine Research Institute
Article Title
Outcome of Pregnancy in Homozygous Sickle Cell Disease
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Journal Title
Obstetrics and Gynecology
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Reprint Status
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Date of Publication
2004
Volume ID
103
Issue ID
6
Page(s)
1278-1285
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ISSN
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Notes
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Abstract
Objective: Previous reports on pregnancy in homozygous sickle cell (SS) disease are biased towards hospital-based, more severely affected subjects and may have underestimated recurrent early pregnancy losses. The authors report on pregnancy outcome in a representative sample of SS subjects subsequently referred to as 'subjects' or 'sickle cell subjects' and matched normal controls followed from birth. Methods: The outcomes of 94 pregnancies in 52 subjects and 157 pregnancies in 68 controls followed in a cohort study from birth were presented. Outcome measures included the age at menarche, interval to first pregnancy, outcome of pregnancy, and maternal complications. Possible predictors of low birth weight were assessed. Outcomes were compared by the Kaplan-Meier analysis for interval to first pregnancy and by Student t test, test, or Fisher exact test, as appropriate. Correction was made for multiple testing, and multiple linear regression was used for analysis of birth weight. Results: Compared with controls, SS subjects had later menarche (median age 15.4 versus 13.0 years) and first pregnancy (median age 23.7 versus 20.1 years), and more spontaneous abortions (36% versus 10%). Babies of SS subjects had a lower gestational age (P < .001) and lower birth weight (P < .001), the latter being significantly affected by sickle-related events in pregnancy. There was no difference in pregnancy-induced hypertension, preeclampsia, or antepartum or postpartum hemorrhage, but a retained placenta was marginally more common in SS subjects (Fisher exact test, P = .007 after adjustment for multiple testing). Two SS subjects died, a mortality rate of 2.1%. Conclusion: The increased fetal loss and maternal morbidity in mothers with homozygous sickle cell disease is confirmed.....
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