Maternal and Fetal Outcomes in Sickle Cell Disease: Impact of Anemia and Prophylactic Transfusion

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Sickle cell disease (SCD) is associated with high rates of maternal and fetal complications, including vaso-occlusive crises (VOC), acute chest syndrome, preeclampsia, venous thromboembolism, postpartum hemorrhage, prematurity and small for gestational age (SGA) fetus. We conducted a retrospective cohort study of 68 pregnant women with SCD who delivered at Grady Memorial Hospital between 2018 and 2025 to characterize pregnancy outcomes and identify independent factors associated with complications. Patients were stratified by genotype, hemoglobin (Hb) levels, and transfusion status. Maternal and fetal complications were obtained. Univariate and multivariable analyses were performed with statistical significance set at p <0.05. Results showed maternal and fetal complications rates of 79.4% and 62% respectively, with a maternal mortality rate of 2.9% and a fetal mortality rate of 2.8%. Prophylactic transfusion in patients with HbSS/Sβ0 was associated with lower VOC rates (33.3% vs 67.9%, p=0.038), longer gestation (37.25 vs 34.27 weeks, p=0.002) and improved fetal outcomes.. Maternal Hb <8 g/dL was associated with increased preeclampsia (60% vs 14.6%, p=0.0003) and preterm delivery (57.9% vs 20.4%, p=0.007). Prophylactic transfusion was independently protective against VOC, preeclampsia, and prematurity, whereas HbSS/Sβ0 genotype and Hb <8 g/dL were independent predictors of adverse maternal and fetal outcomes. Placental examination revealed maternal vascular malperfusion in all cases of preeclampsia and SGA with ischemic findings predominant in patients with Hb <8 g/dL. These findings support risk-stratified management of pregnant women with SCD and has informed our ongoing randomized controlled trial (NCT06979492).