Retrospective Survey of Sickle Cell Disease in Pregnancy in a Niger-Delta Nigerian Tertiary Health Center
Authors: Nwabuko Ogbonna Collins , Okoh Adaunwa Dorathy 
Published: October 2019

Abstract
Background: The number of sickle cell disease (SCD) females with pregnancy is increasing worldwide today because of better care for sickle cell patients and an increase in life expectancy for these people. This however poses obstetric complications if pregnancy progresses without adequate care and follow-up. This study aimed at determining the prevalence and challenges of SCD among pregnant women seen in ante-natal clinic in a Niger-delta Nigerian tertiary health center.
Methodology: This was a-ten-year retrospective study of thirty five thousand, nine hundred and seventy six pregnant women seen at the antenatal clinic of Braithwaite Memorial Specialist Hospital (BMSH) (2003-2013). Biomedical data and hemoglobin (Hb) electrophoresis were obtained using hypothesis generation questionnaires and conventional hemoglobin electrophoretic machines respectively. Data analysis was obtained using SPSS version 16.
Result: A total of 35,976 pregnant women registered in the ante-natal clinic within the study period out of which 28,815 (80.09%) were Hb AA, 7,109 (19.77%) were Hb AS, and 52 were Hb SS (prevalence of 1.4 per 1000 pregnant women). The average booking gestational ages of 22.6 and 29.1 weeks were recorded for SCD and non-SCD participants respectively. The higher level of education (Post-secondary and post-graduate) recorded was relatively higher among the SCD (60%) compared to non-SCD (58.05%) population, although this was not statistically significant (Table 1). Hemoglobin concentration below 11 g/dl were recorded by 39.4 % and 80.8% of non-SCD and SCD participants respectively (P=0.001) (Table 2a). The study population recorded 20.8% as Hb AS (Table 2b).
Conclusion: The prevalence of sickle cell disease in pregnancy is on the increase in this region. Anemia, late ante-natal booking, and poor educational empowerment rank among the greatest challenges confronting management of sickle cell disease in pregnancy in Nigeria. Therefore, awareness creation and national policies that will scale up the care of sickle cell disease in pregnancy should be topmost priorities in improving their life expectancies in Nigeria.
Table 1. Levels of Education: SCD Pregnant women compared to Non-SCD Pregnant Levels of Education Frequency n (%) Total n (%) p-value Non HbSS HbSS Primary (1-6) 71 (0.2) - (0) 71 (0.2) <0.05 JSS (1-3) 810 (2.4) 1 (2) 811 (2.4) >0.05 SS (1-3) 13,308 (39.4) 19 (38) 13,417 (39.7) >0.05 Post-Secondary (Tertiary) 19,419 (57.5) 28 (56) 19,447 (57.2) >0.05 Post-graduate (Masters, Ph.D.) 188 (0.55) 2 (4%) 190 (0.5) <0.05 Total 33,756 (100) 50 (100) 33,806 (100)
Table 2. (a) Pattern of Hemoglobin Concentration in HbSS and Non-HbSS Pregnant women Hb Conc. (g/dl) Frequency n (%) Total n (%) p-value Non-HbSS HbSS <11 13,276 (39.2) 42 (80.8) 13,318 (39.3) <0.05 ≥11 20,554 (60.8) 10 (19.2) 20,564 (60.7) <0.05 Total 33,830 (100) 52 (100.0) 33,882 (100) Chi-square: 188.78, p-value = 0.001 Note: Hb Concentration <11.0 g/dl is termed "Anemia in pregnancy" [1],[2]. 34,020 of the registered women had their Hemoglobin concentration documented.
References:
1. World Health Organization (WHO). The prevalence of Anemia in women: a tabulation of available information. Geneva, Switzerland:WHO; 1992. WHO/MCH/MSM/92.2.
2. World Health Organization (WHO). Prevention and Management of Severe Anemia in Pregnancy: Report of a Technical Working Group. Geneva, Switzerland: WHO/FNE/MSM/93.5.

Disclosures
No relevant conflicts of interest to declare.