***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Summary Women with sickle cell disorder are historically known to have significant maternal and perinatal complications but recent studies from developed countries show a change in this trend . This study was a retrospective , case-controlled study of 75 women with haemoglobin SS ( HbSS ) and 150 with haemoglobin AA ( HbAA ) . Data were analysed using χ2-test and independent t-test as appropriate . There were more perinatal ( 18.7 vs 8.8 , p < 0.05 ) and maternal ( 5.3 % vs 0 , p < 0.05 ) deaths in HbSS women compared with HbAA . Birth weight , gestational age at delivery and 1 and 5 min Apgar scores were also significantly lower in the HbSS women . There was no significant difference in the incidence of pre-eclampsia and urinary tract infection between the two groups . Pregnancy in HbSS women is still fraught with maternal and fetal complications . Prospect i ve studies may help clarify the relationship between SCD and specific maternal complications Sickle cell disease ( SCD ) is associated with an increased risk of medical complications during pregnancy . In sub-Saharan Africa , fetal and maternal mortality rates are particularly high . This study evaluated the effect of an active prenatal management program on pregnancy outcome in patients with SCD in an African setting . Pregnant women with SCD attending the National Teaching Hospital in Cotonou ( The Republic of Benin , West Africa ) were recruited before the 28th week of gestation . Management was based on providing information and education about SCD and improving nutritional status , malaria prevention , early detection of bacterial infections , and restricted use of blood transfusion .  Maternal and fetal mortality rates and SCD-related morbidity were the principal variables assessed . One hundred and eight patients ( 42 SS and 66 SC ) with 111 fetuses were included in the study . Thirteen fetal deaths ( from 9 SS and 4 SC mothers ) were recorded and 2 deaths of SC mothers . The maternal mortality rate of 1.8 % was comparable with the overall maternal mortality rate for this maternity unit ( 1.2 % ) . Few SCD-related events were recorded . Plasmodium falciparum malaria infection was the major cause of morbidity . Sixty-three patients ( 19 SS and 44 SC ) successfully completed their pregnancy ( 58.3 % ) without requiring transfusion . Providing pregnant SCD patients with relevant medical care based on simple cost-effective approaches can have a positive impact on SCD-associated morbidity and mortality in an otherwise difficult setting in Africa . ( Blood . 2000;96:1685 - 1689 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To determine the morbidity and outcome of pregnancies complicated by homozygous sickle cell disease ( SCD ) in Bahrain . METHODS A controlled study was conducted of all the pregnancies of women with SCD who were delivered at Salmaniya Medical Complex and affiliate hospitals in Bahrain between January 1 , 1998 , and December 31 , 2002 . RESULTS There were 351 pregnancies with SCD , giving an incidence of 0.67 % . The mean+/-S.D. age of women with SCD was 28.8+/-5.7 years . These women , who were mostly from Shia villages , had more spontaneous abortions than the 351 controls ( 32 % and 12 % , respectively ) . Compared with the control group , the mean+/-S.D. number of pregnancies among women with SCD was 5.0+/-1.9 vs. 5.7+/-3.1 ; birth weight , 2,965+/-540 g vs. 3,457+/-497 g ; rate of preterm deliveries , 25.9 % vs. 12 % ; incidence of intrauterine growth restriction , 10 % to 13 % vs. 4 % to 7 % ; Apgar scores at 1 and 10 min , 8.1+/-0.8 and 8.8+/-0.8 ; and cesarean section rate , 19.0 % vs. 12.7 % . There were no differences in the rates of pre-eclampsia , antepartum and postpartum hemorrhage , or stillbirth . There were 4 maternal deaths directly related to SCD complications . Hemoglobin analysis was performed in 86 % of the women with SCD . Of these women , 60.6 % had homozygous SCD with raised levels of fetal hemoglobin ( more than 5 % HbF ) ; 9.6 % had sickle cell hemoglobin with beta-thalassemia disease ; and 1.4 % had sickle cell hemoglobin only . Vaso-occlusive crises were the most common cause of hospital admissions during pregnancy ( 42.2 % ) , while hemolytic and sequestration crises accounted for 28.0 % and 0.6 % of admissions . CONCLUSION Mortality , morbidity , and perinatal loss are still considerable among women with SCD in Bahrain . To reduce mortality and morbidity , there is a need for a multidisciplinary team able to deal with pregnancy complications due to SCD Objective To evaluate the maternal and fetal outcome in pregnant women with sickle cell disease and to highlight the complications encountered during pregnancy and delivery at a university hospital in the Eastern Saudi Arabia . Study design A retrospective study of 255 pregnancies in 145 patients with sickle cell disease ( SCD ) over an 8-year-period analyzed the perinatal complications and maternal and fetal outcomes compared with a control group of 500 Saudi females with the normal hemoglobin phenotype selected r and omly that matched for age , parity and delivered during the study period . Results The incidence of SCD was 1.3 % of all deliveries with one maternal death ( 0.4 % ) and a perinatal mortality rate of 78.2/1,000 deliveries in the series . The major maternal complications in the 255 pregnancies were anemia 84.3 % , sickle cell crisis 44.3 % ( 26.6 % painful and 17.7 % hemolytic crises ) , infection 45.9 % , fetal growth restriction 20.1 % , preterm delivery 12.6 % , and pregnancy-induced hypertension 10.6 % . Blood transfusion was necessary in 34 % pregnancies . Stillbirths accounted for 63 % of the perinatal mortality . Conclusions Saudi women with SCD are at a greater risk of morbidity and mortality in pregnancy than previously reported , with a high perinatal mortality rate . Early booking , meticulous antenatal care and supervised hospital delivery will improve the maternal and fetal outcomes in these patients OBJECTIVES To assess fetal growth and whether lower birthweight to mothers with homozygous sickle cell ( SS ) disease is related to maternal body composition or to clinical events in pregnancy . STUDY DESIGN A prospect i ve study of 41 pregnant women with SS disease and 41 women with a normal ( AA ) phenotype attending the antenatal clinic , University Hospital of the West Indies , Kingston , Jamaica . Maternal anthropometry , body composition and fetal sonographic measurements  were assessed at 15 , 25 , and 35 weeks ' gestation from December 2005 to April 2008 . Birth measurements were performed within 24h of delivery . Differences between maternal genotypes and between their offspring were assessed using 2- sample t-tests . Multiple linear regression was used to control for baby 's gender and gestational age at delivery . Fetal growth was compared in SS mothers with and without admission for sickle-related complications including bone pain crisis , acute chest syndrome , pregnancy-induced hypertension and urinary tract infection . RESULTS Mothers with SS disease had lower weight , body fat , fat mass and lean body mass throughout pregnancy but correlation with birth size did not reach statistical significance . Sonographically , babies of SS mothers had smaller abdominal circumference , femoral length and a lower estimated fetal weight at 35 weeks . Birth measurements confirm lower birthweight , crown-heel length and head circumference but the differences were no longer significant after adjustment for baby gender and gestational age at delivery . Bone pain crisis in pregnancy was associated with a significantly reduced crown-heel length at birth . CONCLUSION Lower birthweight in babies of mothers with SS disease is largely the result of the lower gestational age . Fetal sonography showed no growth differences by maternal genotype until 35 weeks ' gestation and a reduced crown-heel length in offspring of SS mothers was associated with bone pain crises in pregnancy Objective To determine the maternal and fetal outcomes of pregnancy in women with sickle cell disease . Methods The subjects were part of a cohort recruited from 19 centers for a prospect i ve study of the clinical course of sickle cell disease . Each participant was evaluated using a structured protocol in which steady-state data and information on both sickle- and non-sickle-related events were colleted . The rates of antepartum and intrapartum complications were tallied for pregnancies carried to delivery . Fetal outcome was assessed according to gestational age , birth weight , and Apgar score . Differences among genotypes in event rates were assessed using Fisher exact test . Differences in gestational age and birth weight , and predictors of these outcomes , were assessed using analyses of covariance . Results Two hundred eighty-six of the 445 reported pregnacies proceeded to delivery . Non-sickle-related antepartum and intrapartum complication rates were comparable with those of African-American women who did not have sickle cell disease . One of the two deaths observed during this study was directly related to the presence of sickle cell disease . Rates of maternal morbidity from sickle cell disease were the same during pregancy as during the nonpregnant state . Ninety-nine percent of those pregnancies carried to delivery result ed in a live birth . Twenty-one percent of the infants born to women of the SS genotype were small for gestational age ( SGA ) . Preclampsia and acute anemic events were identified as risk factors for SGA infants . Conclusion Those caring for women with sickle cell disease should support them if they desire to have children Sickle cell anemia , the homozygous genotype of sickle cell disease is one of the most common heritable diseases in the world . The Arab-Asian haplotype present in India is one of the least severe of all haplotypes . Many sickle cell anemia patients are now leading a symptom-free productive life due to hydroxyurea ( HU ) and better supportive care . Although pregnancy in sickle cell anemia patients is considered a high-risk category , it perinatal outcome is least studied , particularly among carriers of the Arab-Asian haplotype . Thus , the present prospect i ve , r and omized study was performed to assess the perinatal outcome in sickle cell anemia . Neonatal outcome such as low birth weight , perinatal mortality rate , special care newborn unit ( SCNU ) admission , intrauterine growth retardation ( IUGR ) and pre term births were significantly higher in sickle cell anemia mothers . Maternal outcome such as severe anemia , preeclampsia , vasoocclusive crisis ( VOC ) , pulmonary complications , jaundice and blood transfusion requirements were significantly higher in sickle cell anemia mothers , which were successfully managed . Cesarian section rate was not significantly different from normal controls . Successful pregnancies were achieved in 84.44 % of cases . However , we strongly recommend that pregnancies in these patients should be managed in an institutional setup 
    Output:
    
Pregnancy in women with SCD is associated with increased risks of adverse perinatal and maternal outcomes in both low- and high-income countries .
TWEETABLE ABSTRACT This meta- analysis showed worse pregnancy outcomes in women with sickle-cell disease compared with controls