Clinical complications in pregnant women with sickle cell disease: prospective study of factors predicting maternal death or near miss.

[alpha-thalassemia]

To evaluate complications in pregnant women with sickle cell disease , especially those leading to maternal death or near miss (severe obstetric complications ).A prospective cohort of 104 pregnant women registered in the Blood Center of Belo Horizonte (Hemominas Foundation ) was followed up at high -risk prenatal units . They belonged to Group I (51 hemoglobin SS and three hemoglobin S /Î² (0 )-thalassemia ) or Group II (49 hemoglobin SC and one hemoglobin S /Î² (+)-thalassemia ). Both groups had similar median ages . Predictive factors for 'near miss ' or maternal death with p -value â‰¤0 .25 in the univariate analysis were included in a multivariate logistic model (significance set for p -value â‰¤0 .05 ).Group I had more frequent episodes of vaso-occlusive crises , more transfusions in the antepartum and postpartum , and higher percentage of preterm deliveries than Group II . Infections and painful crises during the postpartum period were similar in both the groups . The mortality rate was 4 .8 %: three deaths in Group I and two in Group II . One -third of the women in both the groups experienced near miss . The most frequent event was pneumonia /acute chest syndrome . Alpha-thalassemia co -inheritance and Î²-gene haplotypes were not associated with near miss or maternal death . In multivariate analysis predictors of near miss or death were parity above one and baseline red blood cell macrocytosis . In Group I , baseline hypoxemia (saturation <94 %) was also predictive of near miss or death .One -third of pregnant women had near miss and 4 .8 % died . Both hemoglobin SS and SC pregnant women shared the same risk of death or of severe complications , especially pulmonary events .