Poor lung function linked to fetal death among pregnant women with sickle cell disease
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Pregnant women with sickle cell disease who had poor baseline gestational pulmonary function had significantly greater risk for fetal death, according to study results published in American Journal of Hematology.
These findings suggested that impaired pulmonary function, measured by a reduction in baseline forced expiratory volume in one second (FEV1), can be used as a stratification factor in the perinatal risk assessment of pregnant women with sickle cell disease, and interventions to improve pulmonary function in this group may reduce fetal deaths, according to the researchers.
Researchers previously found that pregnant women with sickle cell disease have an increased risk for maternal and perinatal morbidity and mortality. In the current study, they sought to evaluate whether abnormal pulmonary function is a modifiable risk factor that contributes to these poor outcomes. Because sickle cell disease also can affect the respiratory system, the researchers hypothesized that pulmonary changes during pregnancy — such as rhinitis of pregnancy, sleep-disordered breathing and small airway closure — may reduce maternal pulmonary reserves, compromise uteroplacental function and lower fetal oxygenation.
The analysis included data of 104 pregnant women with sickle cell disease, aged 18 to 41 years, seen at Korle-Bu Teaching Hospital in Ghana from May 2015 to December 2016. The women underwent spirometry testing within 2 weeks of enrollment and were followed for at least 6 weeks while pregnant and 6 weeks following delivery.
Maternal and perinatal mortality rates served as the study’s primary outcomes.
Researchers defined poor lung function as FEV1% predicted to be less than 65%. Ten women met that criteria; the other 94 women had FEV1% predicted to be 65% or greater.
Seven fetal deaths (6.8%; out of 103) occurred, including two among women who died, one from each of the pulmonary function groups.
The rate of fetal death was significantly higher among women with poor pulmonary function (30% vs. 4.3%; P = .01). Results of a multivariable penalized regression model showed FEV1% predicted to be less than 65% was associated with an almost eightfold increased risk for fetal death (OR = 7.81; 95% CI, 1.59-38.38).
The preterm delivery rate of 30.1% in the study cohort was higher than the 10% rate observed among the general population without sickle cell disease. Researchers observed a statistically insignificant increase in preterm delivery rate (50% vs. 28%) and very low birth weight (12.5% vs. 4.3%) among women in the poor pulmonary function group.
Women with poor pulmonary function also demonstrated 33% higher incidence of acute pain episodes and 150% higher incidence of acute chest syndrome. They also had more than twice the rate of hospitalization for malaria and five times the rate of maternal deaths, but none of these differences reached statistical significance.
Researchers cited the small size of the poor pulmonary function group as a study limitation that may have led to the lack of statistically significant findings.
“A study focusing on understanding the mechanisms linking poor gestational pulmonary function and adverse perinatal outcomes in sickle cell disease may be valuable in developing targeted interventions for decreasing fetal deaths,” the researchers wrote.
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