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Blood, 1 September 2000, Vol. 96, No. 5, pp. 1685-1689
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Effect of active prenatal management on pregnancy outcome in
sickle cell disease in an African setting
Mohamed C. Rahimy,
Annick Gangbo,
Roslyn Adjou,
Chantal Deguenon,
Stephanie Goussanou, and
Eusebe Alihonou
From the Newborn Screening for Sickle Cell Disease and
Comprehensive Clinical Care Programs, Unit of Gynecology and
Obstetrics, Faculty of Health Sciences, Cotonou, National University of
Republic of Benin (West Africa).
Sickle cell disease (SCD) is associated with an increased risk of
medical complications during pregnancy. In sub-Saharan Africa, fetal
and maternal mortality rates are particularly high. This study
evaluated the effect of an active prenatal management program on
pregnancy outcome in patients with SCD in an African setting. Pregnant
women with SCD attending the National Teaching Hospital in Cotonou (The
Republic of Benin, West Africa) were recruited before the 28th week of
gestation. Management was based on providing information and education
about SCD and improving nutritional status, malaria prevention, early
detection of bacterial infections, and restricted use of blood
transfusion. Maternal and fetal mortality rates and SCD-related
morbidity were the principal variables assessed. One hundred and eight
patients (42 SS and 66 SC) with 111 fetuses were included in the study.
Thirteen fetal deaths (from 9 SS and 4 SC mothers) were recorded and 2 deaths of SC mothers. The maternal mortality rate of 1.8% was
comparable with the overall maternal mortality rate for this maternity
unit (1.2%). Few SCD-related events were recorded. Plasmodium
falciparum malaria infection was the major cause of morbidity.
Sixty-three patients (19 SS and 44 SC) successfully completed their
pregnancy (58.3%) without requiring transfusion. Providing pregnant
SCD patients with relevant medical care based on simple cost-effective
approaches can have a positive impact on SCD-associated morbidity and
mortality in an otherwise difficult setting in Africa.
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