Impact of antenatal corticosteroid therapy on sickle cell disease in pregnant women

To determine whether antenatal corticosteroids in patients with sickle cell disease are a risk factor for vaso-occlusive crises. We performed a multicenter observational study in 10 centers, including 410 patients with S/S, S/C, S/ sickle cell disease. The primary outcome was the occurrence of vaso-occlusive crises (VOC) during pregnancy. We compared pregnancies with and without exposure to antenatal corticosteroids. Among women who received corticosteriods, potential protective factors and risk factors were analyzed. We performed a propensity score to minimize selection bias. In 40 pregnancies exposed to antenatal corticosteroids, compared to 370 unexposed pregnancies, the incidence of VOC was not significantly higher (62.5% vs. 57.9%, p=0.58) but they were more severe, with more intensive care hospitalizations (25.0% vs 12.9% p=0.04), emergency transfusions (44.7% vs. 22.7%, p< 0.01) and acute chest syndromes (22.5% vs 8.9%, p=0.01, Table). These differences persisted after adjustment for severity and type of sickle cell syndrome (adjusted odd ratios for intensive care admission = 2.73 [95% CI 1.10–6.79], p=0.03 and for acute chest syndrome = 4.15 [95% CI 1.57–14.4], p< 0.01). The incidence of VOC after corticosteroids was not lower in women who had blood transfusions before receiving corticosteroids. When comparing 36 women who received corticosteroids with 63 patients hospitalized for obstetrical complications before 34 weeks’ gestation but who did not receive corticosteroids, there was no significant difference in VOC incidence (41.7% vs 31.5%, respectively, p=0.32), nor of severe VOC. The results did not change when performing an adjustment on a propensity score estimating the probability of receiving antenatal corticosteroids. This study is the first to examine the tolerance of antenatal corticosteroids in sickle cell patients. Antenatal corticosteroids were associated with more severe vaso-occlusive crises, suggesting that they should be avoided and restricted to cases at very high risk of extreme prematurity.