Lower rates of maternal morbidities among pregnant women suffering from sickle cell disease who are exposed to hydroxyurea, a retrospective study from tribal area of Western India

Sickle cell disease (SCD) is a common inherited blood disorder causing high maternal and fetal morbidity during pregnancy. Hydroxyurea (HU) is a standard SCD therapy, but its safety in pregnancy remains uncertain due to concerns about congenital anomalies. This study evaluates maternal-fetal outcomes in pregnant-women with SCD who received HU versus those who did not. A retrospective review was conducted at Kasturba Hospital, Gujarat, India. Pregnant women with SCD who received HU were compared with a historic control group. Maternal morbidities, fetal outcomes, and congenital anomalies were assessed. Poisson regression was done. Among a total of 235 pregnant women with SCD, 154 received HU (440.5 person-months), while 81 did not (269.6 person-months). The HU group had a lower adverse maternal event score (91.2 vs. 109.8 per 100 person-months, adjusted IRR 0.82, 95% CI 0.71-0.96, p = 0.01) and reduced maternal morbidity, blood transfusion needs, complications, and deaths. No significant increase in congenital anomalies was observed. Fetal-outcomes, including live-birth, stillbirth, low birth weight, and prematurity, were comparable between groups, with no statistically significant differences. HU use in pregnancy lowered maternal morbidity without increasing congenital anomalies. Further prospective studies are needed in resource-limited settings.