Maternal and perinatal outcomes among pregnant women with sickle cell disease in Uganda: a prospective cohort study.

Background: Pregnancy in women with sickle cell disease (SCD) is associated with substantial maternal and perinatal risk, but prospective data from Uganda remain limited. We described the clinical profile, maternal complications, and fetal and neonatal outcomes among pregnant women with confirmed SCD receiving tertiary-level care in Uganda. Methods: We conducted a hospital-based prospective cohort study of 159 pregnant women with confirmed HbSS at Kawempe National Referral Hospital and Mbale Regional Referral Hospital, Uganda, between October 2024 and March 2026. Participants were recruited consecutively during antenatal care or at admission for delivery and followed until maternal discharge. Outcomes were summarized descriptively using explicit denominators. Maternal complications were reported at woman level, while fetal and neonatal outcomes were reported at fetus/newborn level to account for multiple gestations. Secondary regression analyses were treated as exploratory. Results: The mean maternal age was 24.3 years (SD 4.7), and 82/159 women (51.6%) were referred in labor or on admission rather than being known from the study-site antenatal clinics. At baseline, median hemoglobin was 7.5 g/dL (IQR 6.4-8.75), and 118/132 women (89.4%) had hemoglobin below 10 g/dL. The most frequent maternal complications were anemia (93/159, 58.5%), vaso-occlusive crisis (87/159, 54.7%), acute chest syndrome (31/159, 19.5%), recurrent infections (27/159, 17.0%), postpartum hemorrhage (21/159, 13.2%), and preeclampsia (17/159, 10.7%). Maternal death occurred in 15/159 women (9.4%). Among women with recorded mode of delivery, 107/137 (78.1%) delivered by caesarean section. The 159 women contributed 166 fetal outcomes, including seven twin pregnancies. Of these, 22/166 (13.3%) were abortions. Among 144 fetal/newborn outcomes after exclusion of abortions, 119/144 (82.6%) were live births and 25/144 (17.4%) were stillbirths. Early neonatal death occurred in 12/119 live births (10.1%). Low birthweight occurred in 76/117 newborns with recorded birthweight (65.0%), and NICU admission was recorded in 83/118 newborns with recorded admission status (70.3%). Conclusion: Pregnancy among women with SCD receiving tertiary referral care in Uganda was characterized by high maternal morbidity, substantial maternal mortality, and poor fetal and neonatal outcomes. The findings support early identification and referral, structured multidisciplinary antenatal care, reliable transfusion readiness, rapid escalation for acute chest syndrome, preeclampsia and infection, and close coordination between obstetric and neonatal services.