Consensus results of the Delphi panel for antenatal care for pregnant individuals with SCD
| Statement . | Agreement % (n/N) . |
|---|---|
| 1.1. Frequency of visits to other specialists and reasons for referral | |
| The patient should consult with OB/GYN at least monthly‡ | 83.3 (10/12) |
| The patient should consult with hematology at least monthly† | 91.7 (11/12) |
| The patient should be offered genetic counseling early in pregnancy† | 100 (12/12) |
| The role of a primary care physician in the follow-up of the pregnancy is limited‡ | 75.0 (9/12) |
| The patient should consult with other disciplines based on clinical need only‡ | 83.3 (10/12) |
| The patient should be referred to cardiology in case of an abnormal routine echocardiogram‡ | 83.3 (10/12) |
| The patient should be referred to cardiology in case of preexisting cardiac issues (eg, pulmonary hypertension), cardiac symptoms during pregnancy (eg, palpitations), and signs/symptoms of peripartum cardiomyopathy† | 91.7 (11/12) |
| The patient should be referred to pulmonology in case of respiratory symptoms during pregnancy (eg, symptoms of obstructive sleep apnea) or low oxygen saturations (<94% on air)† | 91.7 (11/12) |
| The patient should be referred to pulmonology in case of preexisting respiratory issues (eg, asthma)§ | 58.3 (7/12) |
| The patient should be referred to pulmonology in case of an abnormal chest CT scan, pulmonary function test, or sleep study§ | 66.7 (8/12) |
| The patient should be referred to mental health services/psychiatry in case of preexisting mental health issues‡ | 83.3 (10/12) |
| The patient should be referred to mental health services/psychiatry in case of safeguarding concerns for mother and baby‡ | 75.0 (9/12) |
| The patient should be referred to mental health services/psychiatry in case of concerns for onset of psychiatric illness during pregnancy† | 100 (12/12) |
| 1.2. Routine analyses during pregnancy | |
| Decisions about the frequency of ultrasound and Doppler scans for fetal growth monitoring should be made by OB/GYN specialists† | 100 (12/12) |
| Increasing the frequency of ultrasound and Doppler scans in case of chronic opioid use should be decided by OB/GYN specialists† | 100∗ (11/11) |
| Patients should be followed-up more frequently if they were on chronic opioid use§ | 66.7 (8/12) |
| The patient’s blood pressure and urinalysis should be monitored at each clinic visit, at least monthly† | 91.7 (11/12) |
| Urine culture should be performed only as clinically needed§ | 66.7 (8/12) |
| OB/GYN is best positioned for follow-up on blood pressure and urinalysis§ | 66.7 (8/12) |
| 1.3. Thromboembolic disease prophylaxis, infection prophylaxis, and iron supplementation | |
| Thromboembolic disease prophylaxis using an anticoagulant should be started as early as possible in the pregnancy in case of history of thromboembolic disease or antiphospholipid syndrome† | 100 (12/12) |
| Thromboembolic disease prophylaxis using an anticoagulant should be started as early as possible in the pregnancy in case of an additional genetic predisposition for thrombosis (eg, factor V Leiden or prothrombin gene mutation)‡ | 75.0 (9/12) |
| Thromboembolic disease prophylaxis using an anticoagulant should be started as early as possible in the pregnancy in case of additional risk factors (eg, obesity, older age, immobility, and multiparity)§ | 66.7 (8/12) |
| Thromboembolic disease prophylaxis should be started from 28 weeks of pregnancy (or earlier in case of hospitalization) in the absence of these aforementioned risk factors§ | 58.3 (7/12) |
| Thromboembolic disease prophylaxis started during pregnancy should be maintained for 6 to 8 weeks after delivery‡ | 75.0 (9/12) |
| A pregnant patient with mild SCD should receive infection prophylaxis using an antibiotic for the duration of their pregnancy in case of a history of recurrent infections in past pregnancies§ | 50.0 (6/12) |
| A pregnant patient with mild SCD should not automatically receive infection prophylaxis using an antibiotic§ | 50.0 (6/12) |
| Iron supplementation during pregnancy is only needed in the presence of low ferritin and/or iron levels† | 91.7 (11/12) |
| 1.4. Nocturnal oxygen | |
| Nocturnal oxygen should not be recommended at home as standard care for the complete duration of the pregnancy‡ | 83.3 (10/12) |
| Nocturnal oxygen should be recommended for pregnant patients with symptoms of nocturnal hypoxia/sleep apnea‡ | 83.3 (10/12) |
| A patient found to have nocturnal hypoxia should be treated with nocturnal oxygen at home† | 100 (12/12) |
| A patient found to be hypoxic at rest with low blood oxygen saturation in the clinic should be referred for a consultation with a pulmonologist for a work-up for potential etiologies of their hypoxia† | 100 (12/12) |
| Nocturnal oximetry should not be recommended for all pregnant patients† | 100 (12/12) |
| 1.5. Prophylactic aspirin | |
| In the absence of contraindications, the patient should start prophylactic aspirin to reduce the risk of developing preeclampsia‡ | 75.0 (9/12) |
| If prophylactic aspirin treatment is started, it should be started by 12 weeks of gestation for maximum benefit‡ | 75.0 (9/12) |
| Prophylactic aspirin treatment started during pregnancy should be stopped by 36 weeks of gestation (or at labor in case of early delivery)† | 91.7 (11/12) |
| If prophylactic aspirin treatment is started, it should be administered at a dose of 81 mg/d§ | 50.0 (6/12) |
| Statement . | Agreement % (n/N) . |
|---|---|
| 1.1. Frequency of visits to other specialists and reasons for referral | |
| The patient should consult with OB/GYN at least monthly‡ | 83.3 (10/12) |
| The patient should consult with hematology at least monthly† | 91.7 (11/12) |
| The patient should be offered genetic counseling early in pregnancy† | 100 (12/12) |
| The role of a primary care physician in the follow-up of the pregnancy is limited‡ | 75.0 (9/12) |
| The patient should consult with other disciplines based on clinical need only‡ | 83.3 (10/12) |
| The patient should be referred to cardiology in case of an abnormal routine echocardiogram‡ | 83.3 (10/12) |
| The patient should be referred to cardiology in case of preexisting cardiac issues (eg, pulmonary hypertension), cardiac symptoms during pregnancy (eg, palpitations), and signs/symptoms of peripartum cardiomyopathy† | 91.7 (11/12) |
| The patient should be referred to pulmonology in case of respiratory symptoms during pregnancy (eg, symptoms of obstructive sleep apnea) or low oxygen saturations (<94% on air)† | 91.7 (11/12) |
| The patient should be referred to pulmonology in case of preexisting respiratory issues (eg, asthma)§ | 58.3 (7/12) |
| The patient should be referred to pulmonology in case of an abnormal chest CT scan, pulmonary function test, or sleep study§ | 66.7 (8/12) |
| The patient should be referred to mental health services/psychiatry in case of preexisting mental health issues‡ | 83.3 (10/12) |
| The patient should be referred to mental health services/psychiatry in case of safeguarding concerns for mother and baby‡ | 75.0 (9/12) |
| The patient should be referred to mental health services/psychiatry in case of concerns for onset of psychiatric illness during pregnancy† | 100 (12/12) |
| 1.2. Routine analyses during pregnancy | |
| Decisions about the frequency of ultrasound and Doppler scans for fetal growth monitoring should be made by OB/GYN specialists† | 100 (12/12) |
| Increasing the frequency of ultrasound and Doppler scans in case of chronic opioid use should be decided by OB/GYN specialists† | 100∗ (11/11) |
| Patients should be followed-up more frequently if they were on chronic opioid use§ | 66.7 (8/12) |
| The patient’s blood pressure and urinalysis should be monitored at each clinic visit, at least monthly† | 91.7 (11/12) |
| Urine culture should be performed only as clinically needed§ | 66.7 (8/12) |
| OB/GYN is best positioned for follow-up on blood pressure and urinalysis§ | 66.7 (8/12) |
| 1.3. Thromboembolic disease prophylaxis, infection prophylaxis, and iron supplementation | |
| Thromboembolic disease prophylaxis using an anticoagulant should be started as early as possible in the pregnancy in case of history of thromboembolic disease or antiphospholipid syndrome† | 100 (12/12) |
| Thromboembolic disease prophylaxis using an anticoagulant should be started as early as possible in the pregnancy in case of an additional genetic predisposition for thrombosis (eg, factor V Leiden or prothrombin gene mutation)‡ | 75.0 (9/12) |
| Thromboembolic disease prophylaxis using an anticoagulant should be started as early as possible in the pregnancy in case of additional risk factors (eg, obesity, older age, immobility, and multiparity)§ | 66.7 (8/12) |
| Thromboembolic disease prophylaxis should be started from 28 weeks of pregnancy (or earlier in case of hospitalization) in the absence of these aforementioned risk factors§ | 58.3 (7/12) |
| Thromboembolic disease prophylaxis started during pregnancy should be maintained for 6 to 8 weeks after delivery‡ | 75.0 (9/12) |
| A pregnant patient with mild SCD should receive infection prophylaxis using an antibiotic for the duration of their pregnancy in case of a history of recurrent infections in past pregnancies§ | 50.0 (6/12) |
| A pregnant patient with mild SCD should not automatically receive infection prophylaxis using an antibiotic§ | 50.0 (6/12) |
| Iron supplementation during pregnancy is only needed in the presence of low ferritin and/or iron levels† | 91.7 (11/12) |
| 1.4. Nocturnal oxygen | |
| Nocturnal oxygen should not be recommended at home as standard care for the complete duration of the pregnancy‡ | 83.3 (10/12) |
| Nocturnal oxygen should be recommended for pregnant patients with symptoms of nocturnal hypoxia/sleep apnea‡ | 83.3 (10/12) |
| A patient found to have nocturnal hypoxia should be treated with nocturnal oxygen at home† | 100 (12/12) |
| A patient found to be hypoxic at rest with low blood oxygen saturation in the clinic should be referred for a consultation with a pulmonologist for a work-up for potential etiologies of their hypoxia† | 100 (12/12) |
| Nocturnal oximetry should not be recommended for all pregnant patients† | 100 (12/12) |
| 1.5. Prophylactic aspirin | |
| In the absence of contraindications, the patient should start prophylactic aspirin to reduce the risk of developing preeclampsia‡ | 75.0 (9/12) |
| If prophylactic aspirin treatment is started, it should be started by 12 weeks of gestation for maximum benefit‡ | 75.0 (9/12) |
| Prophylactic aspirin treatment started during pregnancy should be stopped by 36 weeks of gestation (or at labor in case of early delivery)† | 91.7 (11/12) |
| If prophylactic aspirin treatment is started, it should be administered at a dose of 81 mg/d§ | 50.0 (6/12) |