Doppler predictors of perinatal outcomes in sickle cell disease: 11-year analysis of genotype and aspirin effects

• HbSS/HbSβThal 0 pregnancies, though more severe, showed no differences in uterine artery Doppler findings compared to HbSC/HbSβThal + . • Low-dose aspirin influenced the predictive value of Doppler indices and may reduce placental dysfunction severity. Maternal and fetal Doppler abnormalities are linked to adverse perinatal outcomes in high risk pregnancies, but genotype-specific data in sickle-cell disease (SCD) is limited. This study aimed to investigate these associations and evaluated the Dopplers’ diagnostic accuracy in predicting adverse outcomes in SCD pregnancies. A retrospective analysis was done of singleton non-anomalous pregnancies with SCD in Jamaica (2012 – 2022) monitored using second-trimester uterine artery (UtA) along with third-trimester umbilical artery (UmA) and middle-cerebral artery (MCA) Dopplers. Outcomes included term or preterm delivery, stillbirth, fetal growth restriction (FGR), neonatal intensive care unit (NICU) admission, and neonatal death (NND). Logistic regression identified predictors of adverse outcomes, and Doppler diagnostic accuracy was assessed against FGR at birth. Low dose aspirin (LDA) was examined as a confounder to Doppler irregularities. Of the 98 pregnancies evaluated, all FGR cases (10.2%) occurred in the HbSS /HbSβThal 0 group (p = 0.011). Doppler abnormalities did not differ significantly between HbSS/HbSβThal 0 and HbSC/HbSβThal + genotypes (UtA: p = 0.652; UmA: p = 1.000; MCA: p = 0.366). Abnormal UtA and cerebral redistribution (CR) were observed in both stillbirths (n = 2). CR predicted FGR with an adjusted odds ratio (aOR) of 33.7 (CI 1.4 – 788.7, p <0.05) for LDA. UmA Doppler exhibited high diagnostic accuracy (90.2%) for FGR, with 100% accuracy in HbSC/HbSβThal + pregnancies and 84.9% in HbSS/ HbSβThal 0 . Doppler velocimetry effectively predicts FGR and stillbirth in SCD pregnancies, with UmA Doppler showing excellent diagnostic utility across genotypes.