Strengths and limitations
This study has a number of key strengths. Our study contributes unique data, as there are no prior studies evaluating the impact of maternal pulmonary function on perinatal outcomes in SCD. The prospective study design has inherent strengths including a decreased likelihood of recall bias. The study participants received care from a multi-disciplinary team including local obstetricians and gynecologists, hematologists, midwives, laboratory scientists, a pediatrician, and a dual‐certified anesthesiologist and pulmonologist, as well as SCD experts from Vanderbilt University and an obstetrician and gynecologist from Duke University Medical Center. This ensured higher quality decision-making and standardized patient care 20.
A significant limitation to this study is the lack of pre-gestational pulmonary function test. In persons with chronic lung disease, pre-gestational FEV1% predicted is known to correlate well with pregnancy outcomes 21,22. However, changes in maternal pulmonary function during pregnancy may not be influenced by pre-gestational pulmonary function status 21. Our study is also limited by phenotype distribution (HbSS versus HbSC). However, the differences in proportion of HbSS and HbSC in the FEV1% predicted groups were not statistically significant.