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Pregnancy outcomes with hydroxyurea use in women with sickle cell disease.

Publication ,  Journal Article
Kroner, BL; Hankins, JS; Pugh, N; Kutlar, A; King, AA; Shah, NR; Kanter, J; Glassberg, J; Treadwell, M; Gordeuk, VR ...
Published in: Am J Hematol
May 2022

Hydroxyurea reduces pain crises, acute chest syndrome, and blood transfusions in sickle cell disease (SCD), but potential detrimental effects on fertility and birth outcomes impede its use. Data on the effects of hydroxyurea taken for SCD during conception and pregnancy are scarce. The Sickle Cell Disease Implementation Consortium collected self-reported pregnancy history, corresponding hydroxyurea use, and pregnancy outcomes in women with SCD in the clinical setting. Among 1285 women 18-45 years of age, 737 (57.4%) reported 1788 pregnancies (1079 live births, 394 miscarriages, 40 stillbirths, 207 abortions, 48 current pregnancies, and 20 missing outcomes) of which 241 (15.9%) live births, miscarriages or stillbirths were conceived while on hydroxyurea. In univariate analyses, pregnancy number more than three, severe sickle genotype, history of stillbirth or miscarriage, and chronic kidney disease at enrollment were covariates significantly associated with a pregnancy ending in miscarriage or stillbirth. After adjustment for covariates and additional SCD severity markers in multivariate analyses, hydroxyurea use during conception and pregnancy, but not during conception only, was associated with an increase in the odds ratio (OR) of miscarriage or stillbirth (OR 2.21, 95% confidence interval [CI] 1.40-3.47). In analyses of live birth outcomes, hydroxyurea use during conception and pregnancy was associated with birth weight < 5.5 pounds in full-term infants (OR 2.98, 95% CI 1.09-7.38) but not with prematurity or serious medical problems at birth. These findings suggest that hydroxyurea use may be safe up to the time of conception, but that clinicians should continue to advise caution regarding use during pregnancy.

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Published In

Am J Hematol

DOI

EISSN

1096-8652

Publication Date

May 2022

Volume

97

Issue

5

Start / End Page

603 / 612

Location

United States

Related Subject Headings

  • Pregnancy Outcome
  • Pregnancy
  • Live Birth
  • Infant, Newborn
  • Infant
  • Immunology
  • Hydroxyurea
  • Humans
  • Female
  • Anemia, Sickle Cell
 

Citation

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Kroner, B. L., Hankins, J. S., Pugh, N., Kutlar, A., King, A. A., Shah, N. R., … Sickle Cell Disease Implementation Consortium. (2022). Pregnancy outcomes with hydroxyurea use in women with sickle cell disease. Am J Hematol, 97(5), 603–612. https://doi.org/10.1002/ajh.26495
Kroner, Barbara L., Jane S. Hankins, Norma Pugh, Abdullah Kutlar, Allison A. King, Nirmish R. Shah, Julie Kanter, et al. “Pregnancy outcomes with hydroxyurea use in women with sickle cell disease.Am J Hematol 97, no. 5 (May 2022): 603–12. https://doi.org/10.1002/ajh.26495.
Kroner BL, Hankins JS, Pugh N, Kutlar A, King AA, Shah NR, et al. Pregnancy outcomes with hydroxyurea use in women with sickle cell disease. Am J Hematol. 2022 May;97(5):603–12.
Kroner, Barbara L., et al. “Pregnancy outcomes with hydroxyurea use in women with sickle cell disease.Am J Hematol, vol. 97, no. 5, May 2022, pp. 603–12. Pubmed, doi:10.1002/ajh.26495.
Kroner BL, Hankins JS, Pugh N, Kutlar A, King AA, Shah NR, Kanter J, Glassberg J, Treadwell M, Gordeuk VR, Sickle Cell Disease Implementation Consortium. Pregnancy outcomes with hydroxyurea use in women with sickle cell disease. Am J Hematol. 2022 May;97(5):603–612.
Journal cover image

Published In

Am J Hematol

DOI

EISSN

1096-8652

Publication Date

May 2022

Volume

97

Issue

5

Start / End Page

603 / 612

Location

United States

Related Subject Headings

  • Pregnancy Outcome
  • Pregnancy
  • Live Birth
  • Infant, Newborn
  • Infant
  • Immunology
  • Hydroxyurea
  • Humans
  • Female
  • Anemia, Sickle Cell