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Category: Medical/Surgical/Diseases/Complications
Poster Session III
To determine whether antenatal corticosteroids in patients with sickle cell disease are a risk factor for vaso-occlusive crises.
Study Design:
We performed a multicenter observational study in 10 centers, including 410 patients with S/S, S/C, S/b sickle cell disease. The primary outcome was the occurrence of vaso-occlusive crises (VOC) during pregnancy. We compared pregnancies with and without exposure to antenatal corticosteroids. Among women who received corticosteriods, potential protective factors and risk factors were analyzed. We performed a propensity score to minimize selection bias.
Results:
In 40 pregnancies exposed to antenatal corticosteroids, compared to 370 unexposed pregnancies, the incidence of VOC was not significantly higher (62.5% vs. 57.9%, p=0.58) but they were more severe, with more intensive care hospitalizations (25.0% vs 12.9% p=0.04), emergency transfusions (44.7% vs. 22.7%, p< 0.01) and acute chest syndromes (22.5% vs 8.9%, p=0.01, Table). These differences persisted after adjustment for severity and type of sickle cell syndrome (adjusted odd ratios for intensive care admission = 2.73 [95% CI 1.10–6.79], p=0.03 and for acute chest syndrome = 4.15 [95% CI 1.57–14.4], p< 0.01). The incidence of VOC after corticosteroids was not lower in women who had blood transfusions before receiving corticosteroids. When comparing 36 women who received corticosteroids with 63 patients hospitalized for obstetrical complications before 34 weeks’ gestation but who did not receive corticosteroids, there was no significant difference in VOC incidence (41.7% vs 31.5%, respectively, p=0.32), nor of severe VOC. The results did not change when performing an adjustment on a propensity score estimating the probability of receiving antenatal corticosteroids.
Conclusion:
This study is the first to examine the tolerance of antenatal corticosteroids in sickle cell patients. Antenatal corticosteroids were associated with more severe vaso-occlusive crises, suggesting that they should be avoided and restricted to cases at very high risk of extreme prematurity.
Florence Wang, MD, MSc
Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Hôpital Louis Mourier, and FHU PREMA
Paris, France, France
Laurent Mandelbrot, MD, PhD
Department of Obstetrics and Gynaecology, LouisMourier Hospital, FHU PREMA, AP-HP, Université de Paris
Paris, France, France
Louis Affo, MD
Assistance Publique-Hôpitaux de Paris, Department of Internal Medicine, Hôpital Louis Mourier
Paris, France, France
Frederic Galacteros, MD
Assistance Publique-Hôpitaux de Paris, Red cell Genetic Disease Unit; Department of Internal medicine; GHU Henri Mondor; U-PEC
Créteil, Ile-de-France, France
Stéphane Bounan, MD
Department of Obstetrics and Gynecology, Hôpital Delafontaine
Saint Denis, France, France
Hervé Fernandez, MD
Department of Obstetrics and Gynecology, Hôpital Bicêtre
Le Kremlin-Bicêtre, France, France
Axel Fichez, MD
Department of Obstetrics and Gynecology, Hôpital de la Croix-Rousse
Lyon, Rhone-Alpes, France
Giovanna Cannas, MD
Sickle Cell Disease Reference Center, Hôpital E. Herriot, HCL
Lyon, Rhone-Alpes, France
Marine Driessen, MD
Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Hôpital Necker, AP-HP
Paris, France, France
véronique Houfflin-Debarge, PhD
University of Lille
Lille, Nord-Pas-de-Calais, France
Gylna Loko, MD
Sickle Cell Disease Reference Center, Hôpital La Meynard, France, Martinique
Mayi Gnofam, MD, MSc
Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Hôpital Louis Mourier, and FHU PREMA
Paris, France, France
Caroline Makowski, MD
Department of Internal Medicine, Centre Hospitalier Universitaire Grenoble Alpes
Grenoble, Rhone-Alpes, France
Olivier Graesslin, MD
Department of Obstetrics and Gynecology, Hôpital Maison Blanche, Reims
Reims, Champagne-Ardenne, France
Bassam Haddad, MD, MS
Department of Obstetrics and Gynecology, Centre Hospitalier Inter Communal Créteil, Université Paris-Est Créteil, IMRB INSERM U955
Creteil, Ile-de-France, France
Jeanne Sibiude, MD, PhD
Assistance Publique-Hôpitaux de Paris, Department of Obstetrics and Gynecology, Hôpital Louis Mourier, and FHU PREMA
Paris, France