Download PDF
Am J Perinatol 2014; 31(09): 805-810
DOI: 10.1055/s-0033-1361931
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Sickle Hemoglobinopathies on Pregnancy-Related Venous Thromboembolism

Blake Porter
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Nigel S. Key
2   Department of Medicine, University of North Carolina, North Carolina
,
Victoria Chapman Jauk
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Soheir Adam
3   Department of Medicine, Duke University, Durham, North Carolina
,
Joseph Biggio
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan Tita
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

21 March 2013

16 October 2013

Publication Date:
12 December 2013 (online)

    Permissions and Reprints

Abstract

Objective The aim of the study is to examine the relationship between sickle cell trait (Hb AS) and other sickle hemoglobinopathies and the risk of thromboembolism during pregnancy or the puerperium.

Study Design Retrospective cohort study of African American women receiving prenatal care from 1991 to 2006. Sickle cell status was ascertained by routine hemoglobin electrophoresis. Venous thromboembolism (VTE) was defined as one or more episodes of deep venous and/or pulmonary thromboembolism during pregnancy or the puerperium according to discharge diagnoses based on International Classification of Diseases, Ninth Revision codes.

Results Among 22,140 women with hemoglobin (Hb) AA status, 20 women (0.09%) experienced pregnancy-related VTE compared with 3 women (0.15%) of 2,037 women with Hb AS; relative risk (RR) for the association with AS status = 1.6; 95% confidence interval (CI) 0.5 to 5.5. Of 103 women, 3 women (2.9%) with sickle cell disease conditions (Hb SS, Hb SC, or Hb S,beta-thalassemia) experienced thromboembolism. Compared with women with Hb AA status, the RR = 32.2, 95% CI 9.7 to 107.

Conclusion Sickle cell trait may be associated with a modest increase in VTE in the setting of pregnancy; sickle cell disease conditions are strongly associated with this rare but potentially fatal outcome.

Keywords

sickle cell disease - sickle cell trait - venous thromboembolism - pregnancy
 

  • References

  • 1 Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton III LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143 (10) 697-706
    CrossrefPubMedGoogle Scholar
  • 2 James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol 2006; 194 (5) 1311-1315
    CrossrefPubMedGoogle Scholar
  • 3 Lindqvist P, Dahlbäck B, Marŝál K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol 1999; 94 (4) 595-599
    CrossrefPubMedGoogle Scholar
  • 4 Chang J, Elam-Evans LD, Berg CJ , et al. Pregnancy-related mortality surveillance—United States, 1991–1999. MMWR Surveill Summ 2003; 52 (2) 1-8
    PubMedGoogle Scholar
  • 5 Weatherall DJ. The inherited diseases of hemoglobin are an emerging global health burden. Blood 2010; 115 (22) 4331-4336
    CrossrefPubMedGoogle Scholar
  • 6 Section on Hematology/Oncology Committee on Genetics; American Academy of Pediatrics. Health supervision for children with sickle cell disease. Pediatrics 2002; 109 (3) 526-535
    CrossrefPubMedGoogle Scholar
  • 7 Brousseau DC, Panepinto JA, Nimmer M, Hoffmann RG. The number of people with sickle-cell disease in the United States: national and state estimates. Am J Hematol 2010; 85 (1) 77-78
    PubMedGoogle Scholar
  • 8 Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med 2010; 38 (4, Suppl) S512-S521
    CrossrefPubMedGoogle Scholar
  • 9 Rickles FR, O'Leary DS. Role of coagulation system in pathophysiology of sickle cell disease. Arch Intern Med 1974; 133 (4) 635-641
    CrossrefPubMedGoogle Scholar
  • 10 Key NS, Slungaard A, Dandelet L , et al. Whole blood tissue factor procoagulant activity is elevated in patients with sickle cell disease. Blood 1998; 91 (11) 4216-4223
    PubMedGoogle Scholar
  • 11 Westerman MP, Green D, Gilman-Sachs A , et al. Coagulation changes in individuals with sickle cell trait. Am J Hematol 2002; 69 (2) 89-94
    CrossrefPubMedGoogle Scholar
  • 12 Austin H, Key NS, Benson JM , et al. Sickle cell trait and the risk of venous thromboembolism among blacks. Blood 2007; 110 (3) 908-912
    CrossrefPubMedGoogle Scholar
  • 13 Austin H, Lally C, Benson JM, Whitsett C, Hooper WC, Key NS. Hormonal contraception, sickle cell trait, and risk for venous thromboembolism among African American women. Am J Obstet Gynecol 2009; 200 (6) e1-e3
    PubMedGoogle Scholar
  • 14 Tita AT, Biggio JR, Chapman V, Neely C, Rouse DJ. Perinatal and maternal outcomes in women with sickle or hemoglobin C trait. Obstet Gynecol 2007; 110 (5) 1113-1119
    CrossrefPubMedGoogle Scholar
  • 15 Villers MS, Jamison MG, De Castro LM, James AH. Morbidity associated with sickle cell disease in pregnancy. Am J Obstet Gynecol 2008; 199 (2) e1-e5
    PubMedGoogle Scholar
  • 16 Pintova S, Cohen HW, Billett HH. Sickle cell trait: is there an increased VTE risk in pregnancy and the postpartum?. PLoS ONE 2013; 8 (5) e64141
    CrossrefPubMedGoogle Scholar
  • 17 Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol 2009; 114 (6) 1326-1331
    CrossrefPubMedGoogle Scholar
  • 18 Mishell Jr DR, Thorneycroft IH, Nakamura RM, Nagata Y, Stone SC. Serum estradiol in women ingesting combination oral contraceptive steroids. Am J Obstet Gynecol 1972; 114 (7) 923-928
    PubMedGoogle Scholar
  • 19 O'Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy. Best Pract Res Clin Obstet Gynaecol 2003; 17 (3) 385-396
    CrossrefPubMedGoogle Scholar
  • 20 White RH, Brickner LA, Scannell KA. ICD-9-CM codes poorly indentified venous thromboembolism during pregnancy. J Clin Epidemiol 2004; 57 (9) 985-988
    CrossrefPubMedGoogle Scholar
  • 21 Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ. Venous thromboembolism in the outpatient setting. Arch Intern Med 2007; 167 (14) 1471-1475
    CrossrefPubMedGoogle Scholar