Scientific Poster Session II - Original Research

Original Research
  Sunday, November 12, 2023
  12:45 PM–02:15 PM

Abstract

Introduction: Pregnant persons with sickle cell disease (SCD) experience increased morbidity and mortality. There is limited data regarding guideline-directed management of SCD-related complications and outcomes in pregnant patients in the inpatient setting.

Research Question or Hypothesis: To what degree do pregnant patients in the inpatient setting receive guideline-directed management of SCD. Secondary endpoints included healthcare resource utilization, maternal outcomes, and fetal outcomes.

Study Design: Multi-center, retrospective cohort study.

Methods: IRB-approved, chart review of pregnant females with SCD, >18 years old, with emergency or inpatient disposition between January 1, 2018 to January 1, 2023 at two urban academic hospitals. Patients with sickle cell trait or status-post hematopoietic stem cell transplant were excluded. Patient demographics, SCD management, pregnancy management, maternal and fetal outcomes were collected. Analysis included descriptive statistics.

Results: The study included 20 patients with 30 pregnancies; 9 spontaneous abortion, 5 elective abortion, and 11 pregnancies >20 weeks. In pregnancies >20 weeks, there were 50 emergency room visits, 49 inpatient admissions (total inpatient days 356), 36 inpatient admissions due to SCD; median inpatient admissions per patient, length-of-stay, and emergency room visits were 7 (interquartile range: 2-28); 2 days (2-48), and 3 (1-20), respectively. Potentially inappropriate first-trimester hydroxyurea use occurred in 13.3% (4/30). Prenatal vitamins and aspirin were administered during 31/49 and 9/49 inpatient admissions, respectively. Cesarean-section delivery occurred in 54.5% (6/11) of pregnancies >20 weeks. Maternal complications included 2 severe pre-eclampsia and 1 gestational hypertension. Fetal complications included 3/11 intrauterine growth restriction, 2/11 delivered prematurely (1 pre-eclampsia and 1 preterm premature rupture of the membranes), and 2/11 delivered with respiratory distress.

Conclusion: Opportunities exist for improvements in guideline-directed management of SCD as reflected by use of aspirin, prenatal vitamins, and hydroxyurea inappropriately in the first trimester. Frequent emergency and inpatient visits during pregnancy reflect the undue burden of SCD during pregnancy.

Presenting Author

Carmela Ruiz Student pharmacist
University at Buffalo

Authors

Jennifer Abeles DO
Jacobs School of Medicine and Biomedical Sciences

Michele Lauria MD, MS, FACOG
Jacobs School of Medicine and Biomedical Sciences

Nicole Cieri-Hutcherson PharmD, BCPS, NCMP
University at Buffalo School of Pharmacy and Pharmaceutical Sciences