Screening for pulmonary hypertension in pregnant women with sickle cell disease in sub-Saharan AfricaAJOG Global Reports at a Glance

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

AJOG Global Reports (Nov 2024)

Screening for pulmonary hypertension in pregnant women with sickle cell disease in sub-Saharan AfricaAJOG Global Reports at a Glance

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

Affiliations

Alim Swarray-Deen, MD: Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana (Swarray-Deen and Oppong); Corresponding author: Alim Swarray-Deen
Misturah Y. Adana, MD, PhD: Department of Anatomy, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria (Adana)
Micheal A. Alao, MD: Department of Pediatrics, University College Hospital, Ibadan, Nigeria (Alao)
Victoria A.A. Agyen-Frimpong, MD: Department of Medicine & Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana (Agyen-Frimpong)
Adekunle Fakunle, PhD: Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria (Fakunle)
Deda Ogum-Alangea, PhD: Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana (Ogum-Alangea)
David N. Adjei, PhD: Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana (Adjei)
Kwame Yeboah, MD, PhD: Department of Physiology, University of Ghana Medical School, Accra, Ghana (Yeboah)
Yemi Raheem Raji, MD: Nephrology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria (Raji)
Samuel A. Oppong, MD: Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana (Swarray-Deen and Oppong)
James A. Ogunmodede, MD: Department of Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria (Ogunmodede and Wahab)
Kolawole Wahab, MD: Department of Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria (Ogunmodede and Wahab)
Kola Okuyemi, MD: Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN (Okuyemi)

Journal volume & issue: Vol. 4, no. 4
p. 100413

Abstract

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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

Published in AJOG Global Reports

ISSN: 2666-5778 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Gynecology and obstetrics
Website: https://www.journals.elsevier.com/ajog-global-reports

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