Risk factors for immediate postpartum sickle cell disease‐specific maternal morbidity

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Summary Pregnant individuals with sickle cell disease (SCD) are more likely to have postpartum complications. In this retrospective single‐centre study, 201 pregnancies from 145 individuals were assessed between 2000 and 2018 for the presence of a composite of immediate postpartum complications from admission during delivery to discharge, which included vaso‐occlusive pain events, acute chest syndrome, infection (blood, urine, pulmonary) and/or new‐onset hypoxia. Hypoxia was defined as SpO 2 below 92%. An immediate postpartum complication occurred in 74 pregnancies (37%), of which 97% experienced a vaso‐occlusive pain event. No immediate postpartum deaths were recorded. Pregnancies with HbSS/HbSβ0 as compared to HbSC/HbSβ+ had a higher incidence of the composite outcome (51% vs. 19%). On univariate analysis, HbSS/HbSβ0 genotype was associated with a higher likelihood of developing a postpartum complication (OR 4.49, 95%CI 2.35–8.57; p < 0.0001); however, this significance was reduced on multivariable analysis. The strongest risk factors associated with experiencing the composite outcome on multivariable analysis were hypoxia during pregnancy (OR 4.95, 95%CI 1.86–13.23; p = 0.001) and an unscheduled caesarean delivery (OR 2.67; 95%CI 1.26–5.64; p = 0.01). Future studies need to address whether correcting hypoxia and use of predictive scores to guide the need for a scheduled caesarean delivery can reduce immediate postpartum complication rates.