Burden of sickle cell disease in pregnancy: A tertiary hospital experience

Background: Pregnancy in women with sickle cell disease (SCD) is associated with increased maternal and perinatal morbidity due to chronic hemolysis, vaso-occlusive events, and pregnancy-related physiological stress. Despite advances in multidisciplinary care, adverse outcomes remain common, particularly in low- and middle-income settings.

Objective: To assess maternal and neonatal outcomes among women with sickle cell disease managed in Enugu State University Teaching Hospital and compare them with outcomes in women with normal hemoglobin genotype (HbAA).

Methods: This retrospective descriptive and analytical study was conducted at Enugu State University Teaching Hospital. Medical records of 324 pregnancies were reviewed, comprising 66 HbSC, 98 HbSS, and 160 HbAA women. Sociodemographic, clinical, maternal, and neonatal outcome data were extracted and analyzed using SPSS. Comparative analyses were performed and statistical significance was set at p < 0.05.

Results: Women with SCD delivered at significantly lower gestational ages than HbAA controls, with preterm delivery occurring more frequently in HbSS (27.1%) and HbSC (35.5%) compared with HbAA (12.7%). Extreme preterm birth (<32 weeks) occurred only in SCD groups. Mean birth weight was significantly lower in HbSS (2.27 ± 0.45 kg) and HbSC (2.86 ± 0.76 kg) compared with HbAA (3.33 ± 0.91 kg) (p < 0.001). Low birth weight was more prevalent among HbSC (43.5%) and HbSS (21.4%) than HbAA (5.1%). Stillbirth rate was highest in HbSS (22.5%) compared with HbSC (6.1%) and HbAA (1.9%) (p < 0.05). Caesarean section rates were significantly higher among SCD women. Pre-eclampsia was significantly increased in HbSS and HbSC groups, while gestational hypertension was more common in HbSC. Mean hemoglobin levels were significantly lower in SCD women both pre-labor and postpartum, with greater postpartum decline observed in these groups. No maternal deaths were recorded.

Conclusion: Pregnancy in women with sickle cell disease, particularly HbSS genotype, is associated with significantly increased risks of preterm delivery, low birth weight, hypertensive disorders, operative delivery, and perinatal mortality compared with HbAA controls. Although maternal survival was favorable in this tertiary center, substantial maternal and neonatal morbidity persists. Enhanced multidisciplinary management, early antenatal booking, and close surveillance are essential to improving pregnancy outcomes in women with SCD.