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Int J Gynaecol Obstet

Title:		Impact of prenatal corticosteroid therapy on sickle cell disease in pregnant women
Author(s):		Wang F; Mandelbrot L; Affo L; Galacteros F; Bounan S; Fernandez H; Fichez A; Cannas G; Driessen M; Debarge V; Loko G; Gnofam M; Makowski C; Graesslin O; Haddad B; Sibiude J; Drepagest Study G;
Address:		"Department of Obstetrics and Gynecology, Assistance Publique-Hopitaux de Paris, Hopital Louis Mourier, and FHU PREMA, Colombes, France. Universite de Paris, Paris, France. Inserm IAME 1137, Paris, France. Department of Internal Medicine, Assistance Publique-Hopitaux de Paris, Hopital Louis Mourier, Colombes, France. Red Cell Genetic Disease Unit, Department of Internal Medicine, Assistance Publique-Hopitaux de Paris, GHU Henri Mondor; U-PEC, Paris, France. Department of Obstetrics and Gynecology, Hopital Delafontaine, Saint Denis, France. Department of Obstetrics and Gynecology, Assistance Publique-Hopitaux de Paris, Hopital Bicetre, Le Kremlin Bicetre, France. Department of Obstetrics and Gynecology, Hopital de la Croix-Rousse, Lyon, France. Sickle Cell Disease Reference Center, Hopital E. Herriot, HCL, Lyon, France. Department of Obstetrics and Gynecology, Assistance Publique-Hopitaux de Paris, Hopital Necker, AP-HP, Paris, France. Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Lille, Lille, France. Sickle Cell Disease Reference Center, Hopital La Meynard, Fort-de-France, Martinique, France. Department of Internal Medicine, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France. Department of Obstetrics and Gynecology, Hopital Maison Blanche, Reims, France. Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal Creteil, Universite Paris-Est Creteil, IMRB INSERM U955, Creteil, France"
Journal Title:		Int J Gynaecol Obstet
Year:		2023
Volume:		20230509
Issue:		1
Page Number:		243 - 255
DOI:		10.1002/ijgo.14823
ISSN/ISBN:		1879-3479 (Electronic) 0020-7292 (Linking)
Abstract:		"OBJECTIVE: To evaluate safety of prenatal corticosteroids in pregnancies of women with sickle cell disease. METHODS: A multicenter observational study of patients with sickle cell disease, comparing vaso-occlusive crises (VOC) requiring hospital care between pregnancies with versus without prenatal corticosteroids. RESULTS: In 40 pregnancies exposed to prenatal corticosteroids, compared with 370 unexposed pregnancies, VOC were not more frequent (62.5% vs 57.9%, P = 0.578) but they were more severe, with more intensive care hospitalizations (25.0% vs 12.9%, P = 0.039), emergency transfusions (44.7% vs 22.7%, P = 0.006), and acute chest syndromes (22.5% vs 8.9%, P = 0.010). These differences persisted after adjustment for severity and type of sickle cell syndrome (for intensive care admission adjusted odds ratio [aOR] 2.73, 95% confidence interval [CI] 1.10-6.79, P = 0.031 and for acute chest syndrome aOR 4.15, 95% CI 1.57-14.4, P = 0.008). VOC occurred on average 1.2 days following steroid administration. When comparing 36 patients receiving corticosteroids for fetal maturation with 58 patients who were hospitalized for obstetrical complications before 34 weeks of pregnancy but that did not receive corticosteroids, VOC incidence was not significantly higher (41.7% vs 31.5%, P = 0.323). CONCLUSION: The present study was the first to study the impact of prenatal corticosteroids on sickle cell disease. They were associated with more severe VOC, suggesting that steroids should be avoided in these women"
Keywords:		"Humans Female Pregnancy Pregnant Women *Volatile Organic Compounds *Anemia, Sickle Cell/complications/drug therapy Adrenal Cortex Hormones/adverse effects Hospitalization prenatal corticosteroids preterm birth sickle cell disease vaso-occlusive crisis;"
Notes:		"MedlineWang, Florence Mandelbrot, Laurent Affo, Louis Galacteros, Frederic Bounan, Stephane Fernandez, Herve Fichez, Axel Cannas, Giovanna Driessen, Marine Debarge, Veronique Loko, Gylna Gnofam, Mayi Makowski, Caroline Graesslin, Olivier Haddad, Bassam Sibiude, Jeanne eng Multicenter Study Observational Study 2023/05/09 Int J Gynaecol Obstet. 2023 Oct; 163(1):243-255. doi: 10.1002/ijgo.14823. Epub 2023 May 9"