Case Report: Obstetric and COVID-19-Related Morbidity and Mortality in Three Patients with Sickle Hemoglobinopathy.

Approximately 3% of pregnant women have sickle cell disease (SCD). COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a global pandemic in March 2020, resulting in more than 3,500 deaths in Jamaica by April 2023. Sickle cell disease is an immunocompromised state; therefore, contracting COVID-19 may result in adverse maternal/neonatal outcomes. Current literature focusing on individuals of Afro-Caribbean descent is limited. Our objective was to describe the obstetric and neonatal outcomes of pregnant patients with SCD who contracted COVID-19. A retrospective case series was conducted at the University Hospital of the West Indies (Jamaica) from 2020 to 2022. We describe the maternal and neonatal outcomes of three patients with COVID-19 and SCD (including two with hemoglobin SC disease and one with hemoglobin SS disease), with complications including the demise of a mother and a newborn. Vaso-occlusive crisis was the more common presentation. Two patients required ventilatory support. Although previous reports have shown similar clinical sequelae in pregnant and nonpregnant patients with SCD and COVID-19, maternal and neonatal deaths remain possible.

Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy - a balance of risks for aspirin?

OBJECTIVES: Sickle cell disease (SCD) occurs in 2.8 % of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. METHODS: A retrospective comparative analysis of HbSS, HbSC and HbSßThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. RESULTS: Of 120 patients (138 pregnancies), obesity occurred in 36 % (20/56) of the 'non-HbSS' group, i.e. HbSßThal (55 %, 5/9) and HbSC (32 %, 15/47) combined vs. 9.7 % of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal 'near-misses' (OR=10.7, 95 % 3.5-32.3; p<0.001), hospitalizations (OR 7.6, 95 % CI 3.4-16.9; p<0.001), low birth weight (LBW) neonates (OR 3.1, 1.1-8.9; p=0.037) and preterm birth (OR=2.6, 1.2-5.8; p=0.018) compared to HbSC and HbSßThal. Low dose aspirin was prescribed in 43 %. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2 %), were LESS likely to have a live birth (75 v. 95 % (0.2, 0.04-0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46 % (0.5, 0.03-0.9, p=0.03)). CONCLUSIONS: HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.

Pregnancy outcomes of women with cardiac disease.

OBJECTIVE: To determine and predict the maternal and neonatal outcomes of pregnancies occurring in patients with cardiac disease. METHOD: This retrospective review included 147 pregnancies identified from antenatal, delivery, and nursery records. Information concerning the nature and severity of the pre-existing cardiac disease, comorbidities, risk scores, obstetric or cardiac complications, and pregnancy outcomes were collected. The data were analyzed using SPSS Windows version 22. RESULTS: In all, 111 (73.5%) of the cohort had acquired heart disease and 4 (2.7%) of patients belonged to WHO class IV, in which pregnancy is not recommended. Additionally, 12 (8.1%) were categorized as being at significant risk of having a cardiac complication. The proportion of patients that had maternal and perinatal mortality was 6 (4.0%) and 7 (4.8%), respectively. The WHO and CARPREG scoring systems were reliably able to predict cardiac events (P < 0.01). Mothers who received preconception counseling had significantly fewer occurrences of cardiac and obstetric events than those who did not. CONCLUSION: Cardiac disease in pregnancy in women managed at our center was most often an acquired disease. The baseline risk assessment scores accurately predicted the likelihood of adverse cardiac outcomes.

Pregnancy outcomes in systemic lupus erythematosus: experience from a Caribbean center.

BACKGROUND: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune multi-system disorder frequently affecting black women of childbearing age. No published data exist on the obstetric outcomes in a Caribbean population. OBJECTIVE: We analyzed pregnancy outcomes in an Afro-Caribbean cohort of women with SLE at a tertiary university hospital. METHODS: A retrospective cohort study was performed of all pregnant women with SLE prior to pregnancy from January 1990 to December 2021 at the University Hospital of the West Indies (UHWI), Jamaica. Maternal rheumatologic, obstetric, fetal/neonatal data were analyzed. Descriptive statistical analyses were performed. To determine if outcomes were associated with various factors, Spearman's rho was followed by logistic regression analysis to estimate unadjusted odds ratios with statistical significance at p < 0.05. RESULTS: A total of 56 pregnancies in 47 women were identified with SLE. Live births were 87.5%, with 10.7% spontaneous miscarriages and no neonatal deaths. Prednisone was the most used drug in 67.9% of patients. 85% of women had an adverse outcome with an adverse fetal outcome occurring in 55% of cases. Prednisone was associated with an adverse fetal/neonatal outcome (Spearman's rho = 0.38; p = .004). CONCLUSION: In this first Caribbean series on SLE in pregnancy, reasonably successful pregnancy outcomes are achievable in Afro-Caribbean women managed in multidisciplinary centers.

Population Reference Values and Prevalence Rates following Universal Screening for Subclinical Hypothyroidism during Pregnancy of an Afro-Caribbean Cohort.

BACKGROUND: Subclinical hypothyroidism (SCH) has been reported to be associated with adverse pregnancy outcomes, however universal screening and treatment is controversial. OBJECTIVES: Our objectives were to determine population-specific pregnancy reference values (R1) for serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) at 14 weeks' gestation, along with the prevalence of SCH and thyroid peroxidase antibody (TPOAb). METHODS: This was a prospective hospital-based cohort study. 1,402 subjects were recruited. Blood samples were obtained from 769 singleton pregnancies due to default between recruitment and scheduled blood draw. The prevalence of SCH was determined using R1, the laboratory non-pregnant reference values (R2) and previously recommended pregnancy reference values (R3). RESULTS: R1 for TSH and FT4 was 0.03-3.17 mU/l (mean ± SD, 1.1 ± 0.76) and 8.85-17.02 pmol/l (mean ± SD, 11.96 ± 2.06), respectively. The prevalence of SCH using reference values R1, R2 and R3 was 1.4% (11/769), 0.5% (4/769) and 1.9% (15/769). Prevalence was significantly greater using R3 when compared to R2 (p = 0.011). TPOAb prevalence was 2.6%. A significantly greater prevalence of TPOAb was found in subclinical hypothyroid subjects using all three reference values than in euthyroid subjects (∼25 vs. 2%, p < 0.05). CONCLUSIONS: These reference values are the first to be reported for an Afro-Caribbean population. Our findings support the use of pregnancy-specific reference values in our population.

A challenging delivery by EXIT procedure of a fetus with a giant cervical teratoma.

BACKGROUND: Congenital giant neck teratomas are rare tumours associated with high perinatal mortality. Recent advances in prenatal diagnosis and delivery by ex utero intrapartum treatment (EXIT) have improved perinatal outcome. CASE: An otherwise healthy 32-year-old woman, gravida 3, para 2, was referred to our institution at 25 weeks' gestation with a diagnosis of a fetal giant cervical teratoma. Ultrasound and magnetic resonance imaging (MRI) findings suggested airway obstruction in the fetus. An EXIT procedure was attempted but did not result in survival of the baby, despite extensive preoperative planning and the best efforts of a multidisciplinary team. CONCLUSION: Despite prenatal detection and diagnosis of airway compromise in a fetus with a giant neck teratoma, securing the fetal airway can be challenging. This is because massive teratomas can completely distort normal tissue and anatomy.

Obstetric outcomes of women with intracranial neoplasms.

OBJECTIVE: To determine the obstetric outcomes of women diagnosed with a primary intracranial neoplasm prior to or during pregnancy and the puerperium. METHODS: Demographic data, neurologic, obstetric, and neonatal outcomes were extracted retrospectively from charts identified from two hospital databases. RESULTS: Twenty-two patients with 25 pregnancies were identified. Thirteen patients were diagnosed prior to pregnancy (group 1); tumor growth or recurrence during pregnancy occurred in 3 patients. Nine patients were diagnosed during pregnancy and the puerperium (group 2); 7 underwent neurosurgery at a mean gestational age of 27+/-5.7 weeks; 2 experienced permanent visual loss. Significantly more gliomas occurred in group 1, but there were significantly more meningiomas in group 2. Numbers of cesarean delivery, preterm delivery at less than 34 weeks, and NICU admission were higher in group 2 than group 1, but this was not statistically significant. CONCLUSION: Although not statistically significant, neurologic deterioration during pregnancy may be associated with cesarean delivery, preterm delivery, and NICU admission.

Alterations in MAP2 immunocytochemistry in areas 9 and 32 of schizophrenic prefrontal cortex.

A variety of lines of converging evidence implicate the prefrontal cortex (PFC) in schizophrenia. Studies employing Nissl stains have suggested that PFC dendrites may be atrophic in schizophrenia; however, Nissl stains do not reveal dendrites. We employed MAP2 immunocytochemistry, which stains dendrites to examine cortical layers III and V in two areas of the PFC (areas 9 and 32). Occipital cortex (area 17) was examined as a control region. Tissues from seven schizophrenics and seven non-psychiatric controls were examined. Immunostaining was quantitated by area fraction analysis. MAP2 area fraction was decreased in both layers in both regions of PFC, but not in occipital cortex. Area 9 exhibited a 42% reduction in layer V and a 36% reduction in layer III. Area 32 exhibited a 31% reduction in layer V and a 36% reduction in layer III. Neither region exhibited a significant change in the density of pyramidal cells. These data are consistent with the hypothesis of a schizophrenia-associated decrease in dendritic material in the PFC.