Corticosteroid Use in Pregnant Women with SCD Doubles Risk of Severe VOCs

According to a French study, corticosteroids used during pregnancy are a risk factor for more severe vaso-occlusive crises (VOCs) in women with sickle cell disease (SCD).

This risk was especially significant in women with a more severe SCD type and signs of more severe illness. Corticosteroids also increased the likelihood of preterm birth and problems in newborns.

According to the researchers, corticosteroids “should be used only after a multidisciplinary benefit/risk assessment and decision with the patient, when there is a critical risk of very preterm delivery.”

The research, titled “Impact of prenatal corticosteroid therapy on sickle cell disease in pregnant women”, was published in the International Journal of Gynaecology and Obstetrics.

SCD pregnancy is known to be risky, with complications leading to foetal or mother mortality occurring in roughly 1% of all pregnancies in high-resource nations despite improved treatment, according to the study.

VOCs, acute chest syndrome, pre-eclampsia (high blood pressure with organ damage), blood coagulation issues, and infections are all examples of maternal difficulties. Preterm (premature) birth, uterine growth restriction, and mortality are the most common foetal problems.

Researchers conducted a retrospective, observational analysis of maternity units connected with reference SCD centres in France and Martinique to see if there is a link between corticosteroid medication and significant VOCs needing emergency hospital care in pregnant women.

“Two of the patients in the group who received corticosteroids had non-severe VOC before administration; both of them became severe within a few hours and required transfer to intensive care on day 1 and day 2, respectively,” the researchers said.

Corticosteroid-exposed babies were more likely to be delivered preterm and to have greater neonatal problems than those who were not (33.3% vs 4.4%).

Additional research discovered that transfusions or other sorts of preventative therapy had no effect on the incidence of VOCs following corticosteroid usage.

“[Prenatal corticosteroids] are a risk factor for more severe VOC in patients with SCD, especially in S/S SCD and patients with severe baseline characteristics,” the researchers found.