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 dualācertified
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.