Postpartum Tubal Sterilization in Sickle Cell Disease in the 2012-2019 National Inpatient Sample

ImportanceSickle cell disease (SCD) is associated with high-risk pregnancy and low rates of hormonal contraception use. Intersectional vulnerabilities among individuals with SCD in the United States (US) raise historically and socially contingent questions about tubal sterilization in individuals with SCD. However immediate postpartum tubal sterilization (TS) rates among individuals with SCD in the US are unknown. ObjectiveTo compare rates of TS in deliveries to people with SCD and without SCD, and to determine the modifying effect of severe maternal morbidity (SMM) on the odds of TS. Design, Setting, and ParticipantsThis repeated cross-sectional study used the 2012-2019 National Inpatient Sample to estimate the rate of TS among delivery hospitalizations to people with SCD, without SCD (non-SCD), Black people with and without SCD, and people with cystic fibrosis (CF). Logistic regression models estimated the odds of TS between SCD and non-SCD deliveries, SCD and non-SCD deliveries with Black race, and SCD and CF deliveries. We examined whether SMM modified the association between TS and SCD in interaction analyses. ExposureSCD, CF ResultsAmong 29,822,518 deliveries, 6.7% underwent TS. Among 18,860 SCD deliveries, 8.8% underwent TS. Among 2,945 CF deliveries, 6.6% underwent TS. After adjusting for patient and hospital characteristics, SCD had higher odds of TS compared to non-SCD deliveries (aOR= 1.38 [1.06,1.79]) and in a stratified analysis of deliveries coded with Black race (aOR= 1.42 [1.06,1.90]). After adjusting for patient and hospital characteristics, there was no difference in the odds of TS between SCD or CF deliveries (aOR=1.0 [0.51,2.24]). SMM more than doubled the odds of TS in SCD deliveries (interaction: aOR=2.34 [1.57,3.47]; aOR= 2.14 [1.40,3.24] in deliveries coded with Black race). ConclusionEven after accounting for patient and hospital characteristics, people with SCD have higher odds of immediate postpartum TS compared to control groups. SMM at delivery increased the odds of TS in SCD compared to all non-SCD deliveries and compared to CF deliveries. Possibly SMM severity, patient preference, or clinician recommendations inform this finding. SMM is 3-7 times more common in SCD than non-SCD pregnancies and may be a modifiable risk factor for TS in SCD deliveries. KEY POINTS QuestionWhat are the national rates and associations of postpartum tubal sterilization (TS) among deliveries to people with sickle cell disease (SCD) compared to deliveries to people without SCD (non-SCD) and cystic fibrosis (CF)? FindingsFrom 2012-2019, the TS rate was significantly higher in SCD deliveries (88 per 1,000 deliveries) vs non-SCD (67 per 1,000 deliveries) and CF deliveries (66 per 1,000 deliveries). SCD was positively associated with TS. SMM modified the association between TS and SCD by two-fold. MeaningPostpartum TS rate in people with SCD is high; SMM during SCD deliveries significantly increases the odds of postpartum TS.