(858) Sickle cell disease is associated with increased severe maternal morbidity risk in the postpartum period

This retrospective cohort study included all deliveries with gestational age ≥20 weeks at an urban safety net hospital in Atlanta, GA from 2011-2019. The exposure was SCD diagnosis, and the outcome was a composite measure of SMM at delivery admission and up to 42 days postpartum. SMM indicators as defined by the Centers for Disease Control and Prevention were identified using ICD-9 and ICD-10 diagnosis and procedure codes; transfusion of blood products and sickle cell crisis were excluded from the outcome. Bivariate associations between SCD and SMM were analyzed using Chi-squared and Fisher’s exact tests. Multivariable logistic regression was performed with adjustment for appropriate confounders.

Results: Of n=17,354 delivery admissions, n=92 (0.53%) had SCD. Persons with SCD had an increased risk of composite SMM (15.22% vs. 2.29%, p< 0.001), acute renal failure (6.52% vs. 0.71%, p< 0.001), adult respiratory distress syndrome (4.35% vs. 0.17%, p< 0.001), eclampsia/HELLP (1.09% vs. 0.14%, p < 0.05), puerperal cerebrovascular disorders (3.26% vs. 0.10%, p< 0.001), sepsis (4.35% vs. 0.42%, p< 0.001), shock (1.09% vs. 0.16%, p< 0.05), air and thrombotic embolism (5.43% vs. 0.10%, p< 0.001), and ventilation (2.17% vs. 0.09%, p < 0.001) compared to those without SCD. Ultimately, those with SCD had a 6-fold higher odds of experiencing SMM, which remained after adjustment for age, race, body mass index, pregestational diabetes, chronic hypertension, history of stroke, thromboembolism and cardiac disease (OR 6.07, 95% CI 3.2-11.3, p< 0.001).

Conclusion: SCD is associated with increased risk of SMM during delivery admission through 42 days postpartum. Our data are foundational for future studies to assess if patients with SCD require closer postpartum surveillance to mitigate this risk.