Pregnancy- and Disease-Related Morbidity Among Medicaid Enrollees With Sickle Cell Disease.

Whereas pregnancy in sickle cell disease (SCD) is considered high risk, there is limited understanding of pregnancy- and SCD-related morbidity to inform clinical practice and health policy.This retrospective cohort study aimed to describe pregnancy- and disease-related morbidity among individuals with SCD for up to 1 year postpartum using Medicaid claims (2010-2018) linked with newborn screening and clinical reports from four state Sickle Cell Data Collection programs. Medicaid enrollees aged 15-44 years with SCD were included. The most recent delivery hospitalization and associated complications were identified using the International Classification of Diseases nineth and tenth revisions. The main outcomes included pregnancy- and disease-related complications during pregnancy, at delivery, and up to 1 year post-delivery.A total of 1286 individuals met the inclusion criteria (43% were 15-24 years old, 50% were 25-34 years old). Most (n = 957, 74%) were enrolled in Medicaid before pregnancy, 88% (n = 1132) were enrolled within their first 16 weeks of pregnancy, and 68% (n = 876) maintained Medicaid coverage for 1 year postpartum. High incidence of SCD-related morbidities including vaso-occlusive crisis (37.6%) and acute chest syndrome (5.8%), and obstetric complications-preeclampsia/eclampsia (9.6%), antepartum hemorrhage (24.2%), and preterm delivery (28.1%)-were reported through 60 days postpartum. Many individuals continued to have SCD-related complications beyond the 60-day postpartum period, including more than one-third having a vaso-occlusive crisis.Individuals with SCD are at increased risk of pregnancy- and SCD-related morbidity throughout the perinatal period. Medicaid policies that ensure continuous coverage and encourage comprehensive multidisciplinary care models may reduce both SCD and obstetric complications and promote better maternal outcomes.

Duke Scholars

Author Mariam Kayle School of Nursing