Screening for pulmonary hypertension in pregnant women with sickle cell disease in sub-Saharan Africa

AJOG global reports Pub Date : 2024-11-01 DOI:10.1016/j.xagr.2024.100413

Alim Swarray-Deen MD , Misturah Y. Adana MD, PhD , Micheal A. Alao MD , Victoria A.A. Agyen-Frimpong MD , Adekunle Fakunle PhD , Deda Ogum-Alangea PhD , David N. Adjei PhD , Kwame Yeboah MD, PhD , Yemi Raheem Raji MD , Samuel A. Oppong MD , James A. Ogunmodede MD , Kolawole Wahab MD , Kola Okuyemi MD

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引用次数: 0

Abstract

Background

Sickle cell disease (SCD) has evolved from a condition predominantly fatal in childhood to a chronic illness impacting many adults, including women of reproductive age. For females with SCD, pregnancy represents one of the greatest health threats, exacerbating existing health challenges and introducing new risks. Despite advancements in healthcare, routine screening for existing complications like pulmonary hypertension (PH) remains inconsistent, particularly in low- and middle-income countries (LMICs), where the prevalence of SCD is highest.

Objective

This study aimed to assess the feasibility of screening for PH in pregnant women with SCD in LMICs, with the goal of enhancing maternal health outcomes in this vulnerable population.

Study Design

A prospective multi-center feasibility study was conducted from September 2022 to February 2023 at teaching hospitals in Ghana and Nigeria. The study included pregnant women with SCD between 28 and 34 weeks of gestation. Screening for PH utilized a tricuspid regurgitation velocity (TRV) criterion (>2.5 m/s), with adherence to American Society of Echocardiography guidelines. Statistical analysis included descriptive statistics and proportions.

Results

Among 3091 pregnant women attending antenatal care, 88 had SCD (2.8%), and 55 were eligible for the study. We recruited 44 participants (mean age 28.9 years, SD 4.8), with 48% (21/44) SS genotype and 52% (23/44) SC genotype. Most participants (95.3%) had normal TRV (<2.5 m/s), with only one showing elevated TRV, successfully referred. Protocol adherence was 100%. Antenatal outcomes showed 95% echo uptake and 95.7% retention to term whilst postnatal echo follow-up was 43.5%. Notably, 27.1% (10/37) of deliveries required neonatal intensive care unit admission, and 18.2% were preterm. The sole participant with PH required intensive care unit care and experienced a preterm delivery with neonatal death on day 5.

Conclusion

Screening and referral for PH in pregnant women with SCD in LMICs are feasible but face challenges in early diagnosis, healthcare personnel availability, and postnatal follow-up. Strategic planning is crucial to address these challenges and improve outcomes in this high-risk population

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撒哈拉以南非洲镰状细胞病孕妇肺动脉高压筛查

背景镰状细胞病（SCD）已从一种主要在儿童时期致命的疾病演变为一种影响许多成年人（包括育龄妇女）的慢性疾病。对于患有 SCD 的女性来说，怀孕是最大的健康威胁之一，不仅会加剧现有的健康挑战，还会带来新的风险。尽管医疗保健取得了进步，但对肺动脉高压（PH）等现有并发症的常规筛查仍不一致，尤其是在 SCD 患病率最高的中低收入国家（LMIC）。研究设计 2022 年 9 月至 2023 年 2 月，在加纳和尼日利亚的教学医院开展了一项前瞻性多中心可行性研究。研究对象包括妊娠 28 至 34 周的 SCD 孕妇。PH 筛查采用三尖瓣反流速度（TRV）标准（2.5 m/s），并遵循美国超声心动图学会指南。统计分析包括描述性统计和比例。结果在 3091 名接受产前检查的孕妇中，88 人患有 SCD（2.8%），55 人符合研究条件。我们招募了 44 名参与者（平均年龄 28.9 岁，SD 4.8），其中 48% （21/44）为 SS 基因型，52% （23/44）为 SC 基因型。大多数参与者（95.3%）的 TRV 正常（2.5 m/s），只有一人 TRV 升高，并成功转诊。100%的参与者遵守了方案。产前结果显示，95%的受试者接受了回波检查，95.7%的受试者保留到足月，而产后回波随访率为43.5%。值得注意的是，27.1%（10/37）的产妇需要入住新生儿重症监护室，18.2%为早产儿。结论在低收入和中等收入国家对患有 SCD 的孕妇进行 PH 筛查和转诊是可行的，但在早期诊断、医护人员的可用性和产后随访方面面临挑战。要应对这些挑战并改善这一高风险人群的预后，战略规划至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

AJOG global reports Endocrinology, Diabetes and Metabolism, Obstetrics, Gynecology and Women's Health, Perinatology, Pediatrics and Child Health, Urology

CiteScore

1.20

自引率

0.00%

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