Sickle Cell Trait Can Exacerbate COVID-19 Risk During Pregnancy

Having sickle cell trait (SCT) may make pregnant individuals more vulnerable to contracting COVID-19 and experiencing more severe infection, according to a recent study published in Advances in Hematology. These findings emphasize the importance of monitoring and vaccination in pregnant patients affected by SCT.¹

An estimated 300 million people are impacted by SCT across the globe. SCT occurs when someone has a singular, abnormal hemoglobin beta gene allele; however, SCT is not associated with the same symptoms brought on by sickle cell disease (SCD), although affected individuals can still experience sickle-related events brought about by, for example, COVID-19 infection.

Data shows that pregnant individuals have 3 times the risk of contracting COVID vs the general population | image credit: New Africa - stock.adobe.com

While individuals with SCT carry extra risks associated with COVID-19—such as the potential to develop severe pneumonia—pregnancy can also increase one’s vulnerability, as COVID-19 is 3 times more prevalent in pregnant individuals vs the general population. Both SCT and pregnancy can exacerbate the symptoms of COVID-19, therefore, a more comprehensive understanding of what contributes to their susceptibility is necessary. To add to this body of knowledge, Aldecoa et al conducted a study to investigate the factors that influence the chances of a pregnant woman with SCT contracting COVID-19, as well as the associated fetal outcomes.

Researchers used International Classification of Diseases, Tenth Revision codes to identify pregnant patients with SCT throughout 3 Michigan hospitals in 2022. Those with a confirmed SCD diagnosis were not eligible for analysis.

In total, 151 women with SCT were included in this assessment. Within this group, 34% of participants were pregnant and 66% were not pregnant, 85% were Black, 2.75 White, 2% Hispanic, and just over 1% Asian. The participants were aged 32 years on average, with pregnant women being significantly younger than their nonpregnant counterparts (29 vs 34 years on average; P < .05). The authors noted that pregnant individuals experienced a higher incidence of COVID-19 compared with nonpregnant individuals, but this difference was not statistically significant (35% vs 31%).

Part of the authors’ assessment included a multivariable regression analysis, which revealed that pregnant women with SCT who received their COVID-19 vaccine stood at a 90% reduced risk of infection compared with nonvaccinated individuals (OR, 0.102; 95% CI, 0.01-0.950). Additionally, researchers found that comorbidities such as chronic obstructive pulmonary disease or asthma increased a pregnant woman’s likelihood of infection by 9 times (OR, 9.375; 95% CI, 1.090-80.627).

Furthermore, the authors observed that most pregnant women with SCT who endured a COVID-19 had mild-moderate infection, with the exception of 1 participant, and over 70% of their pregnancies had 0 fetal complications.

“In this study, no statistically significant association was found among pregnant women with SCT between COVID-19 infection and various factors including influenza vaccination, obesity, heart conditions, diabetes mellitus, renal disorder, stroke, transient ischemic attack, or mental health conditions,” the authors wrote.

Although significant risk factors were not identified, their findings demonstrate the need for careful monitoring in cases of pregnancy and SCT, as each is independently affects individual responses to infections such as COVID-19. Moreover, this monitoring remains essential because pregnant individuals with SCT carry increased risks for stillbirth, and there is a 50% chance that SCT will be passed down to the child, and a 25% chance that child goes on to develop SCD.²

References

1. Aldecoa KAT, Arsene C, Krishnamoorthy G, et al. Risk and protective factors for COVID-19 infection among pregnant women with sickle cell trait. Adv Hematol. 2024;2024:1595091. doi:10.1155/2024/1595091

2. Rowden A. Sickle cell trait and pregnancy: what to expect. Medical News Today. Updated May 31, 2023. Accessed June 20, 2024. https://www.medicalnewstoday.com/articles/sickle-cell-trait-pregnancy