Sickle cell disease and pregnancy outcomes: a study of the community-based hospital in a tribal block of Gujarat, India|
Desai, Gayatri; Anand, Ankit; Shah, Pankaj; Shah, Shobha; Dave, Kapilkumar; Bhatt, Hardik; Desai, Shrey & Modi, Dhiren
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Sickle cell disease; Pregnancy outcomes; Maternal health; Tribal; Gujarat