A Systematic Review of Haemoglobinopathy Prevalence in Pregnancy

Investigators & Affiliations:

Damian K Francis1, Monika R Asnani2, Affette McCaw Binns3, Shelly Rodrigo4, Ian Hambleton5, Marshall Tulloch Reid1 1Epidemiology Research Unit, Tropical Medicine Research Institute 2Sickle Cell Unit, Tropical Medicine Research Institute 3Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica. 4Department of Public Health and Preventive Medicine, St Georges University, Grenada 5Chronic Disease Research Centre, Tropical Medicine Research Institute, The University of the West Indies, Bridgetown, Barbados

Proposed Budget:

WHO Commissioned Review grant budget submitted USD $66,470

Start Date:

July 2015

End Date:

December 2015

Rationale:

The 5th Millennium Development Goal (MDG5) is to reduce the maternal mortality ratio globally by three quarters, between 1990 and 2015. Whereas maternal deaths worldwide have decreased by ~23% from 1990 to 2013, indirect causes of maternal deaths continue to have a significant impact, with an increasing contribution in some regions. Heamoglobinopathies may have a significant effect on preventing our achieving MDG5. It is generally expected that pregnancy poses higher risks of poor maternal and foetal outcomes in these women with SCD for example there may be many foetal (such as intrauterine growth retardation and foetal death) and maternal (such as pre‐eclampsia and eclampsia, greater frequency of pain episodes, increased thrombotic risk, and maternal death) complications. As the WHO aims to meet the challenge of addressing MDG5, a better understanding of the burden of these haematological disorders and their contribution to maternal morbidity and mortality is needed. Systematic reviews of the literature can provide policy makers, clinicians and patients with the best evidence from several studies to help to guide planning, interventions and decisions about care

Methods:

For haemoglobinopathies in pregnancy, any study type providing prevalence or incidence rates for specified maternal morbidity conditions will be considered for this review. We will include pregnant women or women within one year of delivery in studies reporting on the prevalence of: Sickle Cell Disease: Including Homozygous SS disease, Heterozygous states with Haemoglobins C, Haemoglobin E, β‐thalassaemias A comprehensive search of the published and unpublished literature between 1990 and 2015 irrespective of written language will be conducted by an information specialist. The search will include electronic databases (Medline, Popline, EMBASE, LILACS, etc.); web pages from Ministries of Health for official information and other potentially relevant internet sources (e.g. reproductive health gateway, development gateway, dissertation abstracts, Google Scholar). We will carry out standard systematic review procedures of screening and data extraction; quality appraisal of included studies, and data synthesis. For methodological quality appraisal and data synthesis we will use Newcastle Ottawa scale and STATA™ 12.0 respectively.

Main Results:

Review not yet underway

Expected impact:

To provide the best available evidence to the WHO to aid in meeting the challenge of addressing MDG5, foster a better understanding of the burden of haematological disorders and their contribution to maternal morbidity and mortality. The review will also provide policy makers, clinicians and patients with the best evidence from several studies to help to guide planning, interventions and decisions about care.

Next Steps / Future Plans:

  • Complete protocol for study for search strategy development and implementation.
  • Training of staff
  • Production of the review in accordance with protocol

Training opportunities:

Training will be provided to Research Assistants in systematic review methodology.

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