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In the United States, Black women experience disproportionately worse maternal health outcomes than all other racial groups. To better understand how social determinants of health impact SCD maternal morbidity, we used California's Department of Health Care Access and Information data (1991\u20132019) to estimate the cumulative incidence of pregnancy outcomes in Black women with and without SCD\u2014adjusted for age, insurance status, and Distressed Community Index (DCI) scores. Black pregnant women with SCD were more likely to deliver at a younger age, use government insurance, and live in at\u2010risk or distressed neighborhoods, compared to those without SCD. They also experienced higher stillbirths (26.8, 95% confidence interval [CI]: 17.5\u201336.1 vs. 12.4 [CI: 12.1\u201312.7], per 1000 births) and inpatient maternal mortality (344.5 [CI: 337.6\u2013682.2] vs. 6.1 [CI: 2.3\u20138.4], per 100\u2009000 live births). Multivariate logistic regression models showed Black pregnant women with SCD had significantly higher odds ratios (OR) for sepsis (OR 14.89, CI: 10.81, 20.52), venous thromboembolism (OR 13.60, CI: 9.16, 20.20), and postpartum hemorrhage (OR 2.25, CI 1.79\u20132.82), with peak onset in the second trimester, third trimester, and six\u2009weeks postpartum, respectively. Despite adjusting for sociodemographic factors, Black women with SCD still experienced significantly worse pregnancy outcomes than those without SCD. We need additional studies to determine if early introduction to reproductive health education, continuation of SCD\u2010modifying therapies during pregnancy, and increasing access to multidisciplinary perinatal care can reduce morbidity in pregnant women with SCD.<\/jats:p>","DOI":"10.1002\/ajh.26818","type":"journal-article","created":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T07:28:37Z","timestamp":1672730917000},"page":"440-448","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Pregnancy outcomes in women with sickle cell disease in California"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3082-9114","authenticated-orcid":false,"given":"Oyebimpe O.","family":"Adesina","sequence":"first","affiliation":[{"name":"Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology University of California Davis School of Medicine  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5308-9457","authenticated-orcid":false,"given":"Ann","family":"Brunson","sequence":"additional","affiliation":[{"name":"Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology University of California Davis School of Medicine  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha C.","family":"Fisch","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California San Francisco School of Medicine  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Stanford University School of Medicine; Stanford Maternal &amp; Child Health Research Institute  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1716-1516","authenticated-orcid":false,"given":"Anjlee","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology University of California Davis School of Medicine  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaina M.","family":"Willen","sequence":"additional","affiliation":[{"name":"Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology University of California Davis School of Medicine  Sacramento California USA"},{"name":"Division of Pediatric Pulmonary and Sleep Medicine University of California, Davis School of Medicine  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa H. 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