Outcomes of COVID-19 in Pregnant Women with Sickle Cell Disease in India: A Case Series

COVID-19 outcomes among patients with sickle cell disease or sickle cell trait compared to the general population: a systematic review and meta-analyses

Individuals with sickle cell disease (SCD) and sickle cell trait (SCT) face an increased risk of complications from COVID-19 due to their susceptibility to infections and venous thromboembolism. We selected 28 studies from 3228 references in bibliographic databases to compare COVID-19 outcomes (hospitalization, ICU admission, need for ventilatory support, thromboembolic events, and mortality) between patients with SCD or SCT and control patients. Compared to control patients, the pooled risk of hospitalization was not significantly higher in those with SCT (odds ratio [OR] 1.13, 95% confidence interval [CI] 0.94-1.34) but the pooled risk of death was higher (OR 1.43, 95% CI 1.14-1.78). Compared to controls patients, those with SCD had a much higher pooled risk of hospitalization (OR 7.79, 95% CI 5.13-11.81) and a non-different risk of death once hospitalized (OR 0.82, 95% CI 0.62-1.10), resulting in an overall increased risk of death (OR 1.94, 95% CI 1.26-2.98).

Assessing the prevalence and predictors of anemia among pregnant women in India: findings from the India National Family Health Survey 2019-2021

BACKGROUND

Anemia is more prevalent in low- and middle-income countries including India. Anemia in pregnancy is associated with increased risk of maternal health problems and adverse birth outcomes. This study estimates the prevalence and associated risk factors of anemia among pregnant women in India.

METHODS

This cross-sectional study is based on secondary data from the India National Family Health Survey-V (NFHS-5) conducted during 2019-2021. We extracted data of 27,317 currently pregnant women to estimate the prevalence and contributory factors associated with anemia using descriptive statistics and logistic regression analysis.

RESULTS

The prevalence of anemia among pregnant women in India was 52.2%. Anemia was higher among adolescent women (61.5%), those with no education (59.2%), those belonging to poorest wealth index (61.9%), scheduled tribes (59.3%), and those from the eastern region of India (62.1%). Further, it was more prevalent among women with a habit of smoking, tobacco, or alcohol (63.0%), and women with shorter birth intervals (59.7%). Among Indian states, anemia prevalence was higher in the state of Bihar (63.1%) and the union territory of Ladakh (71.4%). Logistic regression models show that women with no education (aOR = 1.41, 95% CI = 1.27-1.57), belonging to a poorest wealth quintile (aOR = 1.69, 95% CI = 1.51-1.90), and those with a habit of smoking, tobacco, or alcohol (aOR = 1.39, 95% CI = 1.18-1.63) were more anemic than their counterparts. Additionally, women with no education showed a four-times higher risk of severe anemia (aOR = 4.79, 95% CI = 2.75-8.36) than their highly educated counterparts.

CONCLUSION

Anemia affects half of all pregnant women in India. Anemia prevalence is higher among adolescents, illiterate, poor, and tribal communities. Social norm-based interventions and strengthening the community health facilitators should be implemented to reduce the high burden of anemia in India.

Impact of the SARS-CoV-2 infection in individuals with sickle cell disease: an integrative review

Sickle cell disease is the most common hemoglobinopathy among humans. As the condition promotes susceptibility to infections, chronic inflammation, and hypercoagulability disorders, several international agencies have included individuals with this disease in the COVID-19 risk group for severe outcomes. However, available information about the subject is not properly systematized yet. This review aimed to understand and summarize the scientific knowledge about the impact of SARS-CoV-2 infection in patients with sickle cell disease. Searches were performed in the Medline, PubMed, and Virtual Health Library databases based on descriptors chosen according to the Medical Subject Headings. We analyzed studies published between 2020 and October 2022, developed with qualitative, quantitative, or mixed methodology, and written in English, Spanish, or Portuguese. The search resulted in 90 articles organized into six categories. There is disagreement in the literature about how different aspects related to sickle cell disease, such as chronic inflammation status, hypercoagulability, hemolytic anemia, use of hydroxyurea, and access to medical care interference with the clinical course of COVID-19. These topics deserve further investigation. It is evident, however, that the infection may manifest in an atypical way and act as a trigger for the development of sickle cell-specific complications, such as acute chest syndrome and vaso-occlusive crises, conditions that are associated with great morbidity and mortality. Therefore, healthcare professionals must be aware of the different forms of presentation of COVID-19 among these individuals. Specific guidelines and therapeutic protocols, as well as public policies for sickle cell individuals, must be considered.

Systematic review registration

This review (https://doi.org/10.17605/OSF.IO/NH4AS) and the review protocol (https://osf.io/3y649/) are registered in the Open Science Framework platform.

Clinical outcomes of COVID-19 in patients with sickle cell disease and sickle cell trait: A critical appraisal of the literature

Individuals with sickle cell disease (SCD) and sickle cell trait (SCT) have many risk factors that could make them more susceptible to COVID-19 critical illness and death compared to the general population. With a growing body of literature in this field, a comprehensive review is needed. We reviewed 71 COVID-19-related studies conducted in 15 countries and published between January 1, 2020, and October 15, 2021, including a combined total of over 2000 patients with SCD and nearly 2000 patients with SCT. Adults with SCD typically have a mild to moderate COVID-19 disease course, but also a 2- to 7-fold increased risk of COVID-19-related hospitalization and a 1.2-fold increased risk of COVID-19-related death as compared to adults without SCD, but not compared to controls with similar comorbidities and end-organ damage. There is some evidence that persons with SCT have increased risk of COVID-19-related hospitalization and death although more studies with risk-stratification and properly matched controls are needed to confirm these findings. While the literature suggests that most children with SCD and COVID-19 have mild disease and low risk of death, some children with SCD, especially those with SCD-related comorbidities, are more likely to be hospitalized and require escalated care than children without SCD. However, children with SCD are less likely to experience COVID-19-related severe illness and death compared to adults with or without SCD. SCD-directed therapies such as transfusion and hydroxyurea may be associated with better COVID-19 outcomes, but prospective studies are needed for confirmation. While some studies have reported favorable short-term outcomes for COVID-19 patients with SCD and SCT, the long-term effects of SARS-CoV-2 infection are unknown and may affect individuals with SCD and SCT differently from the general population. Important focus areas for future research should include multi-center studies with larger sample sizes, assessment of hemoglobin genotype and SCD-modifying therapies on COVID-19 outcomes, inclusion of case-matched controls that account for the unique sample characteristics of SCD and SCT populations, and longitudinal assessment of post-COVID-19 symptoms.

Associations and Disease-Disease Interactions of COVID-19 with Congenital and Genetic Disorders: A Comprehensive Review

Since December 2019, the COVID-19 pandemic, which originated in Wuhan, China, has resulted in over six million deaths worldwide. Millions of people who survived this SARS-CoV-2 infection show a number of post-COVID complications. Although, the comorbid conditions and post-COVID complexities are to some extent well reviewed and known, the impact of COVID-19 on pre-existing congenital anomalies and genetic diseases are only documented in isolated case reports and case series, so far. In the present review, we analyzed the PubMed indexed literature published between December 2019 and January 2022 to understand this relationship from various points of view, such as susceptibility, severity and heritability. Based on our knowledge, this is the first comprehensive review on COVID-19 and its associations with various congenital anomalies and genetic diseases. According to reported studies, some congenital disorders present high-risk for developing severe COVID-19 since these disorders already include some comorbidities related to the structure and function of the respiratory and cardiovascular systems, leading to severe pneumonia. Other congenital disorders rather cause psychological burdens to patients and are not considered high-risk for the development of severe COVID-19 infection.

Outcomes in neonates born to mothers with COVID-19 during the second wave in India

COVID-19 pandemic has affected all age groups globally including pregnant women and their neonates. The aim of the study was to understand outcomes in neonates of mothers with COVID-19 during the first and second waves of COVID-19 pandemic. A retrospective analysis of 2524 neonates born to SARS-CoV-2-infected mothers was conducted during the first wave (n = 1782) and second wave (n = 742) of the COVID-19 pandemic at five study sites of the PregCovid registry in Maharashtra, India. A significant difference was noted in preterm birth, which was higher in the second wave (15.0%, 111/742) compared to the first wave (7.8%, 139/1782) (P < 0.001). The proportion of neonates requiring NICU admission was significantly higher in the second wave (19.0%, 141/742) as compared to that in the first wave (14.8%, 264/1782) (P < 0.05). On comparing regional differences, significantly higher neonatal complications were reported from Mumbai metropolitan region (P < 0.05). During the second wave of COVID-19, birth asphyxia and prematurity were 3.8- and 2.1-fold higher respectively (P < 0.001). Neonatal resuscitation at birth was significantly higher in second wave (3.4%, 25/742 vs 1.8%, 32/1782) (P < 0.05). The prevalence of SARS-CoV-2 infection in neonates was comparable (4.2% vs 4.6%) with no significant difference between the two waves.

CONCLUSION

Higher incidence of adverse outcomes in neonates born to SARS-CoV-2-infected mothers in the second wave of COVID-19 as compared to the first wave.

TRIAL REGISTRATION

PregCovid study is registered with the Clinical Trial Registry of India (CTRI/2020/05/025423, Registered on 28/05/2020).

WHAT IS KNOWN

• The second wave of COVID-19 was more lethal to pregnant women than the first wave. Newborns are at risk of developing complications.

WHAT IS NEW

• Birth asphyxia, prematurity, and neonatal resuscitation at birth were significantly higher in the second wave as compared to those in the first wave of the COVID-19 pandemic in India.