Prospective Cohort Study of eDiary Acute Pain Assessments in Sickle Cell Disease During Third Trimester and Postpartum.

Abstract

Pregnant women with sickle cell disease (SCD) are at higher risk of SCD-related morbidity and mortality compared to after pregnancy. Existing data from healthcare utilization suggest increased acute vaso-occlusive pain events during pregnancy, particularly in the 3rd trimester and puerperium (6 weeks after childbirth). Many acute vaso-occlusive pain events are managed at home and may not capture the full scope of pregnancy-related morbidity. To date, no studies have examined daily self-reported acute vaso-occlusive pain events during pregnancy and after pregnancy to assess their occurrence at home. Based on self-report using an eDiary mobile application, we tested the primary hypothesis that self-reported acute SCD pain events during pregnancy (3rd trimester to puerperium) are greater than after pregnancy (beginning of 6 to end of 9 months after childbirth).In a tertiary care hospital in Ghana, we approached 42 pregnant women with SCD ≤16 weeks gestation to participate in the prospective study; 95.2% (40/42) of pregnant women with SCD agreed to participate; only 33 participants completed 71.5% of expected eDiary mobile application entries during and after pregnancy. The eDiary data revealed a 1.85-fold higher self-reported acute SCD pain incidence rate during pregnancy compared to after pregnancy (0.74 vs. 0.40 events per person-month; p<0.001).