{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:31:53Z","timestamp":1793395913758,"version":"4.5.0"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Pregnancy outcomes are historically poor among people with sickle cell disease (SCD) in the US, most of whom have Black race. Whether outcomes have improved is unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To tabulate adverse pregnancy outcomes among patients with SCD, comparing outcomes of deliveries among Black people with SCD with those of Black people without SCD and a control non-Black population, and to measure the association of racial disparities with adverse outcomes in SCD pregnancies.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study was a secondary analysis involving data from National Inpatient Sample, a nationally representative sample of 20% of acute hospital admissions in the US, between 2012 and 2018. The data set included all admissions with codes for delivery of a pregnancy among people aged 11 to 55 years. Data were analyzed from September 2021 to August 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>SCD, racial disparities.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Severe maternal morbidity (SMM) as measured by the US Centers for Disease Control and Prevention\u2019s index alongside other outcomes; multiple logistic regression was used to compare the odds for adverse pregnancy outcomes.<\/jats:p><\/jats:sec>Results<\/jats:title>The sample included 5\u202f401\u202f899 deliveries, including 3901 deliveries among people with SCD and 742\u202f164 deliveries among people with Black race. Compared with the non-Black control group, patients with SCD and Black patients were younger (mean [SD] age: SCD, 27.2 [5.9] years; Black, 27.1 [6.1] years vs 28.7 [5.9] years) and more likely to have public insurance (SCD, 2609 deliveries [67.3%]; Black, 496\u202f828 deliveries [65.4%] vs 1\u202f880\u202f198 deliveries [40.8%]). The maternal mortality rate in deliveries among people with SCD was 26 times greater than in the non-Black control group and more than 10 times greater than among Black pregnant people without SCD (Per 10\u202f000 deliveries: SCD 13.3; 95% CI, 5.7-31.2; Black race, 1.2; 95% CI, 1.0-1.5; non-Black control 0.5; 95% CI, 0.5-0.6). Compared with the control group, SCD deliveries had higher odds of SMM (adjusted odds ratio [aOR], 7.22; 95% CI, 6.25-8.34; P<\/jats:italic>\u2009&amp;lt;\u2009.001), especially cerebrovascular events (aOR, 22.00; 95% CI, 15.25-31.72; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and thromboembolism (aOR, 17.34; 95% CI, 11.55-26.03; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Racial disparities explained a median (IQR) 28.9% (21.2%-33.1%) of the increased risk in deliveries to people with SCD and between 40% and 50% of the increased risk for acute kidney failure (excess risk [ER], 56.9%; 95% CI, 54.3%-59.3%), intrauterine fetal demise (ER, 47.8%; 95% CI, 46.6%-49.1%), and eclampsia (ER, 42.1%; 95% CI, 37.9%-46.1%).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this large cross-sectional study of pregnancy outcomes in people with SCD, the risk for SMM was higher compared with deliveries among people without SCD, especially for thrombotic events, organ failure, and death. Racial disparities were associated with adverse outcomes. Our findings compel scientific, clinical, and political effort to improve outcomes for pregnant people with SCD.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.54552","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T16:12:32Z","timestamp":1675354352000},"page":"e2254552","source":"Crossref","is-referenced-by-count":62,"title":["Severe Maternal Morbidity and Mortality in Sickle Cell Disease in the National Inpatient Sample, 2012-2018"],"prefix":"10.1001","volume":"6","author":[{"given":"Macy L.","family":"Early","sequence":"first","affiliation":[{"name":"Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahizechukwu C.","family":"Eke","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine & Clinical Pharmacology, Department of Gynecology and Obstetrics, Johns Hopkins University School 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