Congenital abnormalities amongst babies born to women with sickle cell disease and exposed to hydroxyurea during pregnancy: A systematic review

Abstract

Background: Sickle cell disease (SCD) is the commonest hereditary disorder. It is characterized by painful crises and a shortened  lifespan. Hydroxyurea is a bone marrow suppressant used in the treatment of SCD, however, its teratogenicity precludes its use in  pregnancy. Nonetheless, some case studies and series show no adverse outcomes when it is used in pregnancy.

Inclusion criteria: This review considered studies that reported pregnancy outcomes in women with SCD who had been exposed to  hydroxyurea.

Methods: A three-step strategy was used to search databases (Web of Science, Cumulative Index to Nursing and Allied  Health Literature (CINAHL), Mednar, WHO, Google Scholar, Cochrane CENTRAL, EMBASE and MEDLINE via PubMed. OAIster (via  Worldcat.org), PsycExtra, and OpenSIGLE were used to search for gray literature and/or unpublished studies) from inception of database  to August 2022.

Results: Twenty-two studies (N=407 pregnancies) were identified. Thirteen were cohort studies, one randomized control  trial, five case series and three case reports. Overall, included studies had a low risk of bias. The 407 pregnancies comprised of an ectopic  pregnancy, 28 elective terminations, 93 spontaneous miscarriages, 12 stillbirths, a blighted ovum, 264 live births, and 8 had no reported  outcome. No congenital anomaly was reported among the 264 pregnancies that resulted in live births. In one preterm birth, the baby had  a patent ductus arteriosus, this is not an unusual finding in preterm neonates, and it eventually closed.

Conclusion: The risk of  congenital malformations attributable to exposure to hydroxyurea for the treatment of SCD during pregnancy is low.