Serum Ferritin and Folate in Pregnant Women with Sickle Cell Disease and their Relationship with Feto-Maternal Outcomes

Abstract

Background: Sub-Saharan Africa has a high prevalence of sickle cell disease, which is a leading cause of morbidity and mortality there. Adverse fetal and maternal outcomes have been found to be associated with pregnant women with the sickle cell disease. Improvements in the understanding of sickle cell disease-associated hematinics in pregnancy could potentially curb the poor pregnancy outcomes observed among this population. Aim: To investigate the effect of serum ferritin and folate level on fetomaternal outcomes. Methodology: This was a case-control study comparing serum ferritin and folate levels of pregnant women with SCD and age-matched controls made up of pregnant HbAA women and non-pregnant women with SCD. The cases and the pregnant HbAA women were obtained from archived data of a well-described cohort of 100 pregnant women who participated in the Sickle Cell Disease Obstetric study (SCOB) at KBTH. The second control group were recruited from the Adult Sickle Cell Clinic at the Ghana Institute of Clinical Genetics, KBTH, Accra. Recruitment of the second control group into the study was done after obtaining voluntary written informed consent from age-matched non-pregnant SCD women. A well-structured data extraction sheet was used to obtain mothers’ sociodemographic and clinical data. The determination of the levels of serum ferritin and folate were done in accordance with standard procedures. The data obtained were analyzed using Statistical Package for Social Science (SPSS) version 25.0, involving descriptive statistics, independent-samples analysis of variance (ANOVA), and correlation, with the alpha level set at 0.05. Results: The pregnant and non-pregnant SCD participants and the pregnant non-SCD participants did not differ from each other with regard to baseline ferritin levels. However, the pregnant SCD participants had significantly higher post-delivery ferritin levels than did the pregnant non-SCD participants (p = 0.001), but not the non-pregnant SCD participants (p = 0.241). The non-pregnant SCD participants also had significantly higher ferritin levels than did the pregnant non-SCD participants after delivery (p = 0.001). Also, the non-pregnant SCD participants had significantly higher folate levels than did the pregnant non-SCD (p < 0.001) and pregnant SCD (p = 0.010) participants. The pregnant SCD participants did not, however, differ from the pregnant non-SCD participants with regard to their folate levels (p = 1.000). Moreover, no significant association was observed between serum folate and maternal outcomes in all the study categories. However, baseline ferritin level was negatively associated with gestational age at delivery (p <0.001), while post-delivery ferritin level was negatively associated with birthweight of baby (p =0.012), baby length (p =0.006), and Apgar score at 1min (p = 0.037). Conclusion: Pregnancy seemed to induce an elevation in ferritin levels among sickle cell disease individuals, but not among those without the condition, as well as an elevation of folate levels in both SCD and non-SCD participants in this study. Also, although folate had no association with feto-maternal outcomes, baseline ferritin level was negatively associated with gestational age at delivery, and post-delivery ferritin level was negatively associated with birthweight of baby, baby length, and Apgar score at 1min