Hemoglobin Cc in Pregnancy; a Case Series of 6-cases Managed Over 7 Years at the University College Hospital, Ibadan

Hemoglobin Cc in Pregnancy; a Case Series of 6-cases Managed Over 7 Years at the University College Hospital, Ibadan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hemoglobin Cc in Pregnancy; a Case Series of 6-cases Managed Over 7 Years at the University College Hospital, Ibadan Oluwasegun Caleb Idowu, Olatunji O. Lawal, Lydia H. Pecker, Olubukola A. Adesina This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8886965/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background: Hemoglobinopathies are the most common genetic defects globally, the majority of them are in sub-Saharan Africa and Southeast Asia. Hemoglobin C is a common hemoglobin variant although the prevalence of homozygous genotype CC (HbCC) is unknown. Approximately 28,000 infants are born annually with HbCC. HbCC is associated with intracellular hemoglobin crystallization with increased viscosity and reduced red blood cell life span. Although HbC is prevalent in much of sub-Saharan Africa, there is little data in the literature to address whether people with HbCC have clinical manifestations and even less is understood about this during pregnancy. Objective: This study describes the clinical features of pregnant women with HbCC. Method: This is a case series of all mothers who delivered at the University College Hospital between 2017 – 2023. All parturients had haemoglobin electrophoresis to determine their haemoglobin genotype in pregnancy. Women with hemoglobinopathies were identified and their case notes were retrieved. Data was extracted from their case notes with the aid of proforma. Results : Among the 11,496 deliveries over the study period, 180 (1.6%) had haemoglobinopathies and N (0.05%) had HbCC. The women with HbCC were aged 31 to 44 with a mean age of 35.7 years. Four (66%) of these women had previous deliveries. Two (33%) had their hemoglobin genotype diagnosed in childhood, others were diagnosed during their first pregnancy. The mean PCV was 27.7(±3.0)%, an they all had less than 33% which is the threshold for anemia diagnosis. Four (two-thirds of them had blood transfusions at least once. Complications reported were bone pain (n=1), hypertensive disorders in pregnancy (n=1), and malaria (n=1). Four had caesarean delivery for obstetric indications or maternal request. Conclusion: HbCC among parturients is rare. Anemia was prevalent among women with HbCC and, as expected, Although bone pain was reported in one of the six cases, there were no features of sickle cell disease among HbCC women. The majority underwent caesarean section for obstetric indications unrelated to their haemoglobin genotype. Figures Figure 1 INTRODUCTION Hemoglobinopathies are the commonest genetic defects globally affecting more than 250 million people with the highest proportion in Sub-Saharan Africa and South-East Asia. 1 Hemoglobin C was first described in 1950 in heterozygous form and the homozygous hemoglobin C was later identified in 1953. 2 Hemoglobin C is a structural variant of normal adult hemoglobin with the substitution of the amino acid at position 6 of the β globin chain from glutamine to lysine. A similar substitution is seen in hemoglobin S from glutamine to valine causing sickle cell disease, a life-limiting disease. 3 Hemoglobin C is a common structural variant of hemoglobin and yet the exact prevalence remains unknown. 3 It has been projected that annually, more than 600,000 and over 28,000 newborns in Africa have hemoglobin AC and hemoglobin CC (HbCC) genotypes respectively. 3 About 4% of young adults in Ibadan were reported to be carriers of the hemoglobin C genotype. The prevalence of hemoglobin SC has been reported to be about 0.1 to 1.1% in Nigeria. 4,5 Heterozygous inheritance of hemoglobin C is a carrier state and is asymptomatic except when inherited with another abnormal beta globin variant like hemoglobin S or β-thalassemia. Hemoglobin SC is a form of sickle cell disease. 6 People with HbCC may have microcytic hyperchromic anemia with high mean corpuscular hemoglobin concentration(MCHC). 7 , 8 Anemia may result from intracellular hemoglobin crystallization predisposing to increased viscosity and reduced red blood cell life span. 8 However, HbCC does not cause intracellular polymerization during low oxygen tension. 9 The extent to which HbCC causes clinical complications is not established. 7 Mild hemolytic anemia, splenomegaly, scleral jaundice, cholelithiasis and abdominal pain are described in with HbCC. 8 The course of pregnancy among women with HbCC is not established, and information is needed to define clinical care. 10 This study evaluated the clinical characteristics of pregnant women with HbCC. MATERIALS AND METHOD The study was conducted at the University College Hospital (UCH) Ibadan, a tertiary health facility and a teaching hospital in Ibadan, the capital city of Oyo state in the southwestern part of Nigeria. The hospital is a referral center for primary and secondary health facilities across the state. This was a cross-sectional review of 7 years of data (January 2017 to December 2023). All parturients had haemoglobin electrophoresis to determine their haemoglobin genotype; women with haemoglobinopathies were identified and their health records retrieved. Proformas were used to extract data from case notes of women with hemoglobinopathies managed at the University College Hospital, Ibadan, over the period under study. The findings among women with HbCC are summarized here and discussed. The principles of ethics were maintained. Identifiable data from the patients were not included to maintain confidentiality. Ethical approval was obtained from the University of Ibadan/University College Hospital Ibadan Ethical Reviewwith the IRB number UI/EC/25/01224 RESULT Among the 11,496 parturients over the study period, 180 (1.6% of all parturients) had a form of hemoglobinopathy in pregnancy (Table 1), 119 (66.1% of women with hemoglobinoathy) had hemoglobin SS, 54 (30% of women with hemoglobinoathy) had hemoglobin SC, others had S-thalasemia and only 6 (0.05% of parturients) had hemoglobin CC (Figure 1). Three per cent of women with hemoglobinopathies in pregnancy had homozygous hemoglobin C. Socio-demographic characteristics The sociodemographic details of the cases of HbCC in pregnancy are described in Table 2. The age of the women ranged from 31 to 44 years, with a mean age of 35.7(±4.3)years and a median age of 35 years. Four of the six subjects had had previous deliveries with at least two children alive. Hemoglobinopathy diagnoses and management before pregnancy In four of six cases, diagnoses of HbCC were made in adulthood during their first pregnancy. One of the women with HbCC reported receiving hematology care on account of her hemoglobin genotype before pregnancy. There were no admissions for crises or haemoglobinopathy-related complications before the index pregnancy in any of the cases. Details of care regarding supportive care received on account of their hemoglobin genotype outside pregnancy are summarized in Table 2.0. Malaria prophylaxis was used in one of the cases as recommended for women with sickle cell disease. Anemia and blood transfusion. The steady-state packed cell volume (PCV) among the cases before pregnancy ranged from 23% to 31% with a mean of 27.7(±3.0)%. All subjects had steady-state PCV below 33% which is the recommended cut-off for anemia. The mean PCV during pregnancy was similar; 27.7±4.7%. Four subjects had received at least one blood transfusion; transfusion was attributed to anemia before the index pregnancy in two cases and during the index pregnancy in two cases. Pregnancy-related complications. As shown in Table 3.0, the complications reported in these women were bone pain(N=1), anemia requiring transfusion (N=2), hypertensive disorders in pregnancy (N=1), and malaria ( N=1). None had hemolytic crises, sepsis, acute chest syndrome, hepatomegaly, splenomegaly, disseminated intravascular coagulopathy, or intrauterine growth restriction. Route of delivery and pregnancy outcomes . One subject had a preterm delivery at a gestational age of 28 weeks. A high proportion (4 out of 6 cases) of the subjects underwent cesarean section due to obstetric indication (N=3) or maternal request (N=1). The choice of route of delivery was thought to not be directly related to their hemoglobin genotype. All subjects had live births with good outcomes: birth weights were average for their gestational age, and all babies were alive by the seventh day of life. Table 1. Prevalence of hemoglobinopathies among parturients at the University College Hospital, Ibadan YEAR TOTAL DELIVERIES HEMOGLOBINOPATHIES Incidence (%) HEMOGLOBIN CC Incidence (%) 2017 1,999 8 (0.4%) 0 2018 1,535 25 (1.6%) 0 2019 2,192 38 (1.7%) 1 2020 1,767 30 (1.7%) 1 2021 963 18 (1.9%) 0 2022 1,633 26 (1.6%) 1 2023 1,407 35 (2.5%) 3 TOTAL 11,496 180 (1.6%) 6 (0.05%) Table 2. Selected socio-demographic, obstetric, and hemoglobinopathy-related characteristics of the women with hemoglobin CC Serial number 1 2 3 4 5 6 Year 2019 2020 2021 2023 2023 2023 Age 44 35 32 31 35 37 Occupation Business Civil servant Teaching Trading Banking Business Level of education Secondary Tertiary Secondary Tertiary Tertiary Tertiary Previous deliveries 4 2 4 3 0 0 Previous miscarriages 0 2 1 0 1 0 Children alive 3 2 4 3 0 0 Age at diagnoses of HbCC 30 30 31 8 6 37 Care for HbCC None None (Specialist) None None None Routine drug use and hematinics None None Paludrine and multivitamins None None Iron, folate & fansidar Previous crises None None None None None None Previous hospital admissions None Two times Three times None None Twice Reason for admission Not applicable Pregnancy-related Pregnancy-related Not applicable Not applicable Surgery (myomectomy) Steady-state PCV 30% 30% 25% 30% 23% 28% Latest PCV 30% 30% 22% 28% 23% 33% Blood transfusion before the index pregnancy 1 1 0 0 0 0 Blood transfusion during the index pregnancy 0 0 0 0 1, 2 units pRBCs 1, 2 units pRBCs Table 3.0 Complications in pregnancy delivery outcomes among women with HbCC Serial number 1 2 3 4 5 6 Complications Bone pain Yes No No No No No Anemia in pregnancy No No No No Yes Yes Malaria No No No No No Yes Chronic hypertension No No No Yes No No Number of fetus(es) 2 1 1 1 1 1 Preeclampsia No No No Yes No No Gestational age delivery 28weeks 38weeks + 3days 39weeks 37weeks +days 37weeks 38weeks + 3days Route of delivery Vaginal Elective CS Vaginal Emergency CS Elective CS Emergency CS Indication (if CS) Not applicable Two previous CS Not applicable Severe pre-eclampsia Maternal request Previous myomectomy Birthweight (kg) 1.05/1.20 3.8k 3.3 3.2 2.55 3.0 APGAR score @1min 3/6 9 9 9 9 9 APGAR score @5min 5/8 9 9 9 10 9 SCBU admission Yes/Yes No No No No No Final fetal outcome (at 7 days) Alive/Alive Alive and well Alive and well Alive and well Alive and well Alive and well Discussion This study describes the profile of parturients with hemoglobin CC at the University College Hospital Ibadan. The prevalence of hemoglobinopathies among parturients at the University College Hospital over the study period is 1.6%. This is consistent with the previously reported prevalence of sickle cell disease in Nigeria. 11 Only 3% of the women considered to have hemoglobinopathies were HbCC genotype; the prevalence of hemoglobin CC in pregnancy at the facility at 0.05%. Although Hemoglon CC in pregnancy is known to be rare, the exact prevalence has not been reported. 2 In this small cohort, HbCC was usually diagnosed in adulthood, especially during routine screening in pregnancy. Routine nationwide hemoglobin genotyping in childhood is not performed in Nigeria, as is the case in most of sub-Saharan Africa. 12, 13 The absence of clinical complications of living with hemoglobin CC may make diagnosis unlikely in childhood. However, the diagnosis of hemoglobin CC has reproductive implications beyond the parturient - in a country where rate of HbS trait and HbSS disease very high - the risk of having a HbSC baby is increased since CC will 100% pass C trait to baby. Piel et al estimated that globally, 28,000 newborns each year are born with hemoglobin CC. 3 HbCC in pregnancy was not associated with any complication in these cases except for anaemia. This is consistent with the findings of Maberry et al that hemoglobin CC in pregnancy may be associated with mild to moderate anemia but crises and other complications are infrequent. 14 The World Health Organization (WHO) has set a hemoglobin concentration of 12g/dL (hematocrit – 36%) as the lower limit of normal among adult women and 11g/dL (hematocrit – 33%) among pregnant women. 15 The average hematocrit levels among the general population of pregnant women in their first trimester reported at the same facility is 35% (32–38%), which may reduce to 29.4% (28.7–29.9%) in the third trimester. 16 All the women in this study had a steady-state hematocrit of less than or equal to 30%, suggesting anemia that worsened in pregnancy, consistent with the published literature. 8 , 14 Multiple perinatal complications may follow sickle cell disease. 17 , 18 However, for those with hemoglobin CC, such complications may be mercifully absent; a larger cohort is needed to draw definitive conclusions for nuanced counseling for women with this genotype. Only one of the women in this study had a preterm delivery. She had twin gestation which is a risk factor for prematurity; this imay be unrelated to her hemoglobin genotype. Women with sickle cell disease and other hemoglobinopathies may be more likely to have preterm birth compared to the general population of pregnant women without hemoglobinopathy. 19 , 20 Regarding the mode of delivery, two-thirds of the subjects in this study had cesarean section due to obstetric indications and maternal request, not from factors related to their haemoglobin genotype. Hemoglobinopathy is not an indication for a cesarean section, but may be associated with a higher rate of cesarean section compared to the general population. 21 This study is limited by its case-series design, reporting only six cases over seven years. Conducting a well-structured multicenter prospective study to generate robust data needed to establish the extent to which women with HbCC require additional monitoring or intervention before and during pregnancy. It is also necessary to compare women with HbCC with appropriately matched women with HbAA or HbAS, or HbAC, to identify deviations from the normal (if any) among women with HbCC before labelling HbCC as a form of hemoglobinopathy Conclusion HbCC among parturients is rare; it is usually asymptomatic, and diagnosis may not be made until adulthood, during pregnancy. Anemia was prevalent among women with HbCC, and, as expected, bone pain was reported in one of the six cases; there were no features of sickle cell disease among HbCC women before or during pregnancy. The majority had a cesarean section for obstetric indications unrelated to their haemoglobin genotype. Declarations Human Ethics This study on human data is in compliance with the Declaration of Helsinki. Consent to Participate Declarations: Retrospective record of managed patient at the University College Hospital, Ibadan were used. The need for individual consent by participants was waived by the University of Ibadan/University College Hospital Ibadan Ethical Review Committee Ethical approval. Ethical approval was obtained from the University of Ibadan/University College Hospital Ibadan Ethical Review Committee with the IRB number UI/EC/25/01224 Funding Declaration No funding was received for this study Authors contribution: IOC and OAA conceptualized the study, data was extracted by IOC, OOL and OAA. The manuscript was drafted by IOC under the supervision of OAA. All authors reviewed the manuscript and made contributions. Declaration of interest: The authors have no conflics of interest to declare Data Availability declaration Data available on request References Abdulrahaman Y, Isaac ZI, Erhabor O, Sanusi BM, Udomah FP, Ezimah AC, et al. Haemoglobin electrophoretic pattern among resident in Sokoto, Nigeria. J Med Disord. 2013;1:2053–3659. Fabry ME, Nagel RL. Hemoglobin CC and SC red cells. In: Genetically Abnormal Red Cells [Internet]. CRC Press; 2019: 71–90. Piel FB, Howes RE, Patil AP, Nyangiri OA, Gething PW, Bhatt S, et al. The distribution of haemoglobin C and its prevalence in newborns in Africa. Sci Rep. 2013;3(1):1671. Kingsley A, Enang O, Essien O, Legogie A, Cletus O, Oshatuyi O. Prevalence of Sickle Cell Disease and Other Haemoglobin Variants in Calabar, Cross River State, Nigeria. Annu Res Rev Biol. 2019; 33(5):1–6. Nubila T, Ukaejiofo EO, Nubila NI, Azeez R. Frequency distribution of hemoglobin variants among Yorubas in Ibadan, south western Nigeria: A pilot study. Niger J Exp Clin Biosci. 2013:1(1 & 2):39. Aljabry M, Suliman S, Alotaibi G, Aljabri H, Alomary S, Adam I, et al. Regional Prevalence of Hemoglobin C across Saudi Arabia: An Epidemiological Survey [Internet]. 2023. Available from: https://www.researchsquare.com Zheng Y, Castro D, Gay D, Cai D. Mean Corpuscular Hemoglobin Concentration in Hemoglobin CC, SC, and AC. North Am J Med Sci [Internet]. 2015;8(1). Cook CM, Smeltzer MP, Mortier NA, Kirk SE, Despotovic JM, Ware RE, et al. The Clinical and Laboratory Spectrum of Hb C [β6(A3)Glu→Lys, G AG> A AG] Disease. Hemoglobin. 2013; 37(1): 16–25. Karna B, Jha SK, Al Zaabi E. Hemoglobin C Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Available from:http://www.ncbi.nlm.nih.gov/books/NBK559043/ Tita AT, Biggio JR, Chapman V, Neely C, Rouse DJ. Perinatal and maternal outcomes in women with sickle or hemoglobin C trait. Obstet Gynecol. 2007;110(5):1113–9. GO E, Onyire N, Orji ML, Achigbu K. Sickle Cell Disease in Nigeria -----------A Review. IOSR J Dent Med Sci. 201716:87–94. Oluwole EO, Adeyemo TA, Osanyin GE, Odukoya OO, Kanki PJ, Afolabi BB. Feasibility and acceptability of early infant screening for sickle cell disease in Lagos, Nigeria—A pilot study. PLOS ONE. 2020;15(12):e0242861. Olatunya OS, Albuquerque DM, Fagbamigbe AF, Faboya OA, Ajibola AE, Babalola OA, et al. Diagnostic Accuracy of HemotypeSC as a Point-of-Care Testing Device for Sickle Cell Disease: Findings from a Southwestern State in Nigeria and Implications for Patient Care in Resource-Poor Settings of sub-Saharan Africa. Glob Pediatr Health. 2021;8:2333794X211016789. Maberry MC, Mason RA, Cunningham FG, Pritchard JA. Pregnancy complicated by hemoglobin CC and C-β-thalassemia disease. Obstet Gynecol. 1990;76(3):324–7. Kinyoki D, Osgood-Zimmerman AE, Bhattacharjee NV, Kassebaum NJ, Hay SI. Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018. Nat Med. 2021; 27(10):1761–82. Akinbami AA, Ajibola SO, Rabiu KA, Adewunmi AA, Dosunmu AO, Adediran A, et al. Hematological profile of normal pregnant women in Lagos, Nigeria. Int J Womens Health. 2013; 5:227–32. Oteng-Ntim E, Meeks D, Seed PT, Webster L, Howard J, Doyle P, et al. Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis. Blood. 2015;125(21):3316–25. Boafor TK, Olayemi E, Galadanci N, Hayfron-Benjamin C, Dei-Adomakoh Y, Segbefia C, Kassim AA, Aliyu MH, Galadanci H, Tuuli MG, Rodeghier M, DeBaun MR, Oppong SA. Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis. BJOG. 2016;123(5):691-8. Fashakin V, Weber JM, Truong T, Craig A, Wheeler SM, James AH. Sickle cell disease and the incidence and etiology of preterm birth. Am J Obstet Gynecol MFM. 2022;4(6):100723. Barfield WD, Barradas DT, Manning SE, Kotelchuck M, Shapiro-Mendoza CK. Sickle Cell Disease and Pregnancy Outcomes: Women of African Descent. Am J Prev Med. 2010;38(4, Supplement):S542–9. Elenga N, Hardy-Dessources M, Dufour P, et al. Pregnancy outcomes in women with sickle cell disease: A French multicenter cohort study. Haematologica . 2021;106(3):793–802. doi:10.3324/haematol.2020.262601 Additional Declarations No competing interests reported. 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Lawal","email":"","orcid":"","institution":"University College Hospital, Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Olatunji","middleName":"O.","lastName":"Lawal","suffix":""},{"id":609034941,"identity":"710c5ddb-3405-43f1-ba4c-587b206cae7a","order_by":2,"name":"Lydia H. Pecker","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Lydia","middleName":"H.","lastName":"Pecker","suffix":""},{"id":609034942,"identity":"87d4d808-a144-4544-9bf8-4ebfde57fd5c","order_by":3,"name":"Olubukola A. Adesina","email":"","orcid":"","institution":"University College Hospital, Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Olubukola","middleName":"A.","lastName":"Adesina","suffix":""}],"badges":[],"createdAt":"2026-02-15 15:23:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8886965/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8886965/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105057108,"identity":"68fb7ec3-6a08-403e-9850-cd65516d76b3","added_by":"auto","created_at":"2026-03-20 11:57:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18959,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eshowing the distribution of hemoglobinopathies over 7 years\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8886965/v1/af6fd338722a8f20d19c1b23.png"},{"id":105562726,"identity":"0ce2d699-03a6-4130-a5f8-be41f7bf3561","added_by":"auto","created_at":"2026-03-27 12:44:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1123122,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8886965/v1/047b55c9-7d41-48e9-b3f6-6c692ee66cdc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHemoglobin Cc in Pregnancy; a Case Series of 6-cases Managed Over 7 Years at the University College Hospital, Ibadan\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHemoglobinopathies are the commonest genetic defects globally affecting more than 250\u0026nbsp;million people with the highest proportion in Sub-Saharan Africa and South-East Asia.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Hemoglobin C was first described in 1950 in heterozygous form and the homozygous hemoglobin C was later identified in 1953.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Hemoglobin C is a structural variant of normal adult hemoglobin with the substitution of the amino acid at position 6 of the β globin chain from glutamine to lysine. A similar substitution is seen in hemoglobin S from glutamine to valine causing sickle cell disease, a life-limiting disease. \u003csup\u003e3\u003c/sup\u003e Hemoglobin C is a common structural variant of hemoglobin and yet the exact prevalence remains unknown. \u003csup\u003e3\u003c/sup\u003e It has been projected that annually, more than 600,000 and over 28,000 newborns in Africa have hemoglobin AC and hemoglobin CC (HbCC) genotypes respectively. \u003csup\u003e3\u003c/sup\u003e About 4% of young adults in Ibadan were reported to be carriers of the hemoglobin C genotype. The prevalence of hemoglobin SC has been reported to be about 0.1 to 1.1% in Nigeria. \u003csup\u003e4,5\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHeterozygous inheritance of hemoglobin C is a carrier state and is asymptomatic except when inherited with another abnormal beta globin variant like hemoglobin S or β-thalassemia. Hemoglobin SC is a form of sickle cell disease.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e People with HbCC may have microcytic hyperchromic anemia with high mean corpuscular hemoglobin concentration(MCHC).\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Anemia may result from intracellular hemoglobin crystallization predisposing to increased viscosity and reduced red blood cell life span.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e However, HbCC does not cause intracellular polymerization during low oxygen tension.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The extent to which HbCC causes clinical complications is not established.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Mild hemolytic anemia, splenomegaly, scleral jaundice, cholelithiasis and abdominal pain are described in with HbCC. \u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe course of pregnancy among women with HbCC is not established, and information is needed to define clinical care.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e This study evaluated the clinical characteristics of pregnant women with HbCC.\u003c/p\u003e"},{"header":"MATERIALS AND METHOD","content":"\u003cp\u003eThe study was conducted at the University College Hospital (UCH) Ibadan, a tertiary health facility and a teaching hospital in Ibadan, the capital city of Oyo state in the southwestern part of Nigeria. The hospital is a referral center for primary and secondary health facilities across the state. This was a cross-sectional review of 7 years of data (January 2017 to December 2023). All parturients had haemoglobin electrophoresis to determine their haemoglobin genotype; women with haemoglobinopathies were identified and their health records retrieved. Proformas were used to extract data from case notes of women with hemoglobinopathies managed at the University College Hospital, Ibadan, over the period under study. The findings among women with HbCC are summarized here and discussed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe principles of ethics were maintained. Identifiable data from the patients were not included to maintain confidentiality. Ethical approval was obtained from the University of Ibadan/University College Hospital Ibadan Ethical Reviewwith the IRB number UI/EC/25/01224\u003c/p\u003e"},{"header":"RESULT","content":"\u003cp\u003eAmong the 11,496 parturients over the study period, 180 (1.6% of all parturients) had a form of hemoglobinopathy in pregnancy (Table 1), \u0026nbsp;119 (66.1% of women with hemoglobinoathy) had hemoglobin SS, 54 (30% of women with hemoglobinoathy) had hemoglobin SC, others had S-thalasemia and only 6 (0.05% of parturients) had hemoglobin CC (Figure 1). Three per cent of women with hemoglobinopathies in pregnancy had homozygous hemoglobin C.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sociodemographic details of the cases of HbCC in pregnancy are described in Table 2. The age of the women ranged from 31 to 44 years, with a mean age of 35.7(\u0026plusmn;4.3)years and a median age of 35 years. \u0026nbsp;Four of the six subjects had had previous deliveries with at least two children alive.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHemoglobinopathy diagnoses and management before pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn four of six\u0026nbsp;cases, diagnoses of HbCC were made in adulthood during their first pregnancy. One of the women with HbCC reported receiving hematology care on account of her hemoglobin genotype before pregnancy. There were no admissions for crises or haemoglobinopathy-related complications before the index pregnancy in any of the cases. Details of care regarding supportive care received on account of their hemoglobin genotype outside pregnancy are summarized in Table 2.0. Malaria prophylaxis was used in one of the cases as recommended for women with sickle cell disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnemia and blood transfusion.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe steady-state packed cell volume (PCV) \u0026nbsp;among the cases before pregnancy ranged from 23% to 31% with a mean of 27.7(\u0026plusmn;3.0)%. All subjects had steady-state PCV below 33% which is the recommended cut-off for anemia. The mean PCV during pregnancy was similar; 27.7\u0026plusmn;4.7%. Four subjects had received at least one blood transfusion; transfusion was attributed to anemia before the index pregnancy in two cases and during the index pregnancy in two cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePregnancy-related complications.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 3.0, the complications reported in these women were bone pain(N=1), anemia requiring transfusion (N=2), hypertensive disorders in pregnancy (N=1), and malaria ( N=1). None had hemolytic crises, sepsis, acute chest syndrome, hepatomegaly, splenomegaly, disseminated intravascular coagulopathy, or intrauterine growth restriction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRoute of delivery and pregnancy outcomes\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eOne subject had a preterm delivery at a gestational age of 28 weeks. A high proportion (4 out of 6 cases) of the subjects underwent cesarean section due to obstetric indication (N=3) or maternal request (N=1). The choice of route of delivery was thought to not be directly related to their hemoglobin genotype. All subjects had live births with good outcomes: birth weights were average for their gestational age, and all babies were alive by the seventh day of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 1. \u0026nbsp; Prevalence of hemoglobinopathies among parturients at the University College Hospital, Ibadan\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.7e+2pt\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eYEAR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL DELIVERIES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHEMOGLOBINOPATHIES\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIncidence (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHEMOGLOBIN CC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIncidence (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1,535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2,192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1,767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1,633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1,407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e11,496\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e180 (1.6%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6 (0.05%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Selected socio-demographic, obstetric, and hemoglobinopathy-related characteristics of the women with hemoglobin CC\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 5.0e+2pt\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSerial number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCivil servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTeaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTrading\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBanking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious deliveries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious miscarriages\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChildren alive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge at diagnoses of HbCC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCare for HbCC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(Specialist)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;None\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRoutine drug use and hematinics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePaludrine and multivitamins\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIron, folate \u0026amp; fansidar\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious crises\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious hospital admissions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTwo times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eThree times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTwice\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eReason for admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePregnancy-related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePregnancy-related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSurgery (myomectomy)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSteady-state PCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLatest PCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBlood transfusion before the index pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBlood transfusion during the index pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1,\u003cbr\u003e\u0026nbsp;2 units pRBCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1,\u003cbr\u003e\u0026nbsp;2 units pRBCs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.0 Complications in pregnancy delivery outcomes among women with HbCC\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 5.0e+2pt\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSerial number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBone pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAnemia in pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMalaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChronic \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of fetus(es)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePreeclampsia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38weeks + 3days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37weeks +days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38weeks + 3days\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRoute of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eElective CS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmergency CS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eElective CS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmergency CS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIndication (if CS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTwo previous CS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNot applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSevere pre-eclampsia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMaternal request\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrevious myomectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBirthweight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.05/1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.8k\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAPGAR score @1min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAPGAR score @5min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSCBU admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes/Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFinal fetal outcome (at 7 days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlive/Alive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlive and well\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlive and well\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlive and well\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlive and well\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlive and well\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study describes the profile of parturients with hemoglobin CC at the University College Hospital Ibadan. The prevalence of hemoglobinopathies among parturients at the University College Hospital over the study period is 1.6%. This is consistent with the previously reported prevalence of sickle cell disease in Nigeria.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Only 3% of the women considered to have hemoglobinopathies were HbCC genotype; the prevalence of hemoglobin CC in pregnancy at the facility at 0.05%. Although Hemoglon CC in pregnancy is known to be rare, the exact prevalence has not been reported.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn this small cohort, HbCC was usually diagnosed in adulthood, especially during routine screening in pregnancy. Routine nationwide hemoglobin genotyping in childhood is not performed in Nigeria, as is the case in most of sub-Saharan Africa. \u003csup\u003e12, 13\u003c/sup\u003e The absence of clinical complications of living with hemoglobin CC may make diagnosis unlikely in childhood. However, the diagnosis of hemoglobin CC has reproductive implications beyond the parturient - in a country where rate of HbS trait and HbSS disease very high - the risk of having a HbSC baby is increased since CC will 100% pass C trait to baby. Piel et al estimated that globally, 28,000 newborns each year are born with hemoglobin CC. \u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHbCC in pregnancy was not associated with any complication in these cases except for anaemia. This is consistent with the findings of Maberry et al that hemoglobin CC in pregnancy may be associated with mild to moderate anemia but crises and other complications are infrequent. \u003csup\u003e14\u003c/sup\u003e The World Health Organization (WHO) has set a hemoglobin concentration of 12g/dL (hematocrit \u0026ndash; 36%) as the lower limit of normal among adult women and 11g/dL (hematocrit \u0026ndash; 33%) among pregnant women.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The average hematocrit levels among the general population of pregnant women in their first trimester reported at the same facility is 35% (32\u0026ndash;38%), which may reduce to 29.4% (28.7\u0026ndash;29.9%) in the third trimester. \u003csup\u003e16\u003c/sup\u003e All the women in this study had a steady-state hematocrit of less than or equal to 30%, suggesting anemia that worsened in pregnancy, consistent with the published literature.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMultiple perinatal complications may follow sickle cell disease.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e However, for those with hemoglobin CC, such complications may be mercifully absent; a larger cohort is needed to draw definitive conclusions for nuanced counseling for women with this genotype. Only one of the women in this study had a preterm delivery. She had twin gestation which is a risk factor for prematurity; this imay be unrelated to her hemoglobin genotype. Women with sickle cell disease and other hemoglobinopathies may be more likely to have preterm birth compared to the general population of pregnant women without hemoglobinopathy.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Regarding the mode of delivery, two-thirds of the subjects in this study had cesarean section due to obstetric indications and maternal request, not from factors related to their haemoglobin genotype. Hemoglobinopathy is not an indication for a cesarean section, but may be associated with a higher rate of cesarean section compared to the general population.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study is limited by its case-series design, reporting only six cases over seven years. Conducting a well-structured multicenter prospective study to generate robust data needed to establish the extent to which women with HbCC require additional monitoring or intervention before and during pregnancy. It is also necessary to compare women with HbCC with appropriately matched women with HbAA or HbAS, or HbAC, to identify deviations from the normal (if any) among women with HbCC before labelling HbCC as a form of hemoglobinopathy\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHbCC among parturients is rare; it is usually asymptomatic, and diagnosis may not be made until adulthood, during pregnancy. Anemia was prevalent among women with HbCC, and, as expected, bone pain was reported in one of the six cases; there were no features of sickle cell disease among HbCC women before or during pregnancy. The majority had a cesarean section for obstetric indications unrelated to their haemoglobin genotype.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study on human data is in compliance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate Declarations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRetrospective record of managed patient at the University College Hospital, Ibadan were used. The need for individual consent by participants was waived by the\u0026nbsp;University of Ibadan/University College Hospital Ibadan Ethical Review Committee\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the\u0026nbsp;University of Ibadan/University College Hospital Ibadan Ethical Review Committee with the IRB number UI/EC/25/01224\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIOC and OAA conceptualized the study, data was extracted by IOC, OOL and OAA. The manuscript was drafted by IOC under the supervision of OAA. All authors reviewed the manuscript and made contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflics of interest to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData available on request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbdulrahaman Y, Isaac ZI, Erhabor O, Sanusi BM, Udomah FP, Ezimah AC, et al. Haemoglobin electrophoretic pattern among resident in Sokoto, Nigeria. J Med Disord. 2013;1:2053\u0026ndash;3659.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFabry ME, Nagel RL. Hemoglobin CC and SC red cells. In: Genetically Abnormal Red Cells [Internet]. CRC Press; 2019: 71\u0026ndash;90.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePiel FB, Howes RE, Patil AP, Nyangiri OA, Gething PW, Bhatt S, et al. The distribution of haemoglobin C and its prevalence in newborns in Africa. Sci Rep. 2013;3(1):1671.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKingsley A, Enang O, Essien O, Legogie A, Cletus O, Oshatuyi O. Prevalence of Sickle Cell Disease and Other Haemoglobin Variants in Calabar, Cross River State, Nigeria. Annu Res Rev Biol. 2019; 33(5):1\u0026ndash;6.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNubila T, Ukaejiofo EO, Nubila NI, Azeez R. Frequency distribution of hemoglobin variants among Yorubas in Ibadan, south western Nigeria: A pilot study. Niger J Exp Clin Biosci. 2013:1(1 \u0026amp; 2):39.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAljabry M, Suliman S, Alotaibi G, Aljabri H, Alomary S, Adam I, et al. Regional Prevalence of Hemoglobin C across Saudi Arabia: An Epidemiological Survey [Internet]. 2023. Available from: https://www.researchsquare.com\u003c/li\u003e\n \u003cli\u003eZheng Y, Castro D, Gay D, Cai D. Mean Corpuscular Hemoglobin Concentration in Hemoglobin CC, SC, and AC. North Am J Med Sci [Internet]. 2015;8(1).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCook CM, Smeltzer MP, Mortier NA, Kirk SE, Despotovic JM, Ware RE, et al. The Clinical and Laboratory Spectrum of Hb C [\u0026beta;6(A3)Glu\u0026rarr;Lys, \u003cem\u003eG\u003c/em\u003e AG\u0026gt; \u003cem\u003eA\u003c/em\u003e AG] Disease. Hemoglobin. 2013; 37(1): 16\u0026ndash;25.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKarna B, Jha SK, Al Zaabi E. Hemoglobin C Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 \u0026nbsp;Available from:http://www.ncbi.nlm.nih.gov/books/NBK559043/\u003c/li\u003e\n \u003cli\u003eTita AT, Biggio JR, Chapman V, Neely C, Rouse DJ. Perinatal and maternal outcomes in women with sickle or hemoglobin C trait. Obstet Gynecol. 2007;110(5):1113\u0026ndash;9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGO E, Onyire N, Orji ML, Achigbu K. Sickle Cell Disease in Nigeria -----------A Review. IOSR J Dent Med Sci. 201716:87\u0026ndash;94.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOluwole EO, Adeyemo TA, Osanyin GE, Odukoya OO, Kanki PJ, Afolabi BB. Feasibility and acceptability of early infant screening for sickle cell disease in Lagos, Nigeria\u0026mdash;A pilot study. PLOS ONE. 2020;15(12):e0242861.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOlatunya OS, Albuquerque DM, Fagbamigbe AF, Faboya OA, Ajibola AE, Babalola OA, et al. Diagnostic Accuracy of HemotypeSC as a Point-of-Care Testing Device for Sickle Cell Disease: Findings from a Southwestern State in Nigeria and Implications for Patient Care in Resource-Poor Settings of sub-Saharan Africa. Glob Pediatr Health. 2021;8:2333794X211016789.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMaberry MC, Mason RA, Cunningham FG, Pritchard JA. Pregnancy complicated by hemoglobin CC and C-\u0026beta;-thalassemia disease. Obstet Gynecol. 1990;76(3):324\u0026ndash;7.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKinyoki D, Osgood-Zimmerman AE, Bhattacharjee NV, Kassebaum NJ, Hay SI. Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018. Nat Med. 2021; 27(10):1761\u0026ndash;82.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAkinbami AA, Ajibola SO, Rabiu KA, Adewunmi AA, Dosunmu AO, Adediran A, et al. Hematological profile of normal pregnant women in Lagos, Nigeria. Int J Womens Health. 2013; 5:227\u0026ndash;32.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOteng-Ntim E, Meeks D, Seed PT, Webster L, Howard J, Doyle P, et al. Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis. Blood. 2015;125(21):3316\u0026ndash;25.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBoafor TK, Olayemi E, Galadanci N, Hayfron-Benjamin C, Dei-Adomakoh Y, Segbefia C, Kassim AA, Aliyu MH, Galadanci H, Tuuli MG, Rodeghier M, DeBaun MR, Oppong SA. Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a\u0026nbsp;systematic review and meta-analysis. BJOG. 2016;123(5):691-8.\u003c/li\u003e\n \u003cli\u003eFashakin V, Weber JM, Truong T, Craig A, Wheeler SM, James AH. Sickle cell disease and the incidence and etiology of preterm birth. Am J Obstet Gynecol MFM. 2022;4(6):100723.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBarfield WD, Barradas DT, Manning SE, Kotelchuck M, Shapiro-Mendoza CK. Sickle Cell Disease and Pregnancy Outcomes: Women of African Descent. Am J Prev Med. 2010;38(4, Supplement):S542\u0026ndash;9. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eElenga N, Hardy-Dessources M, Dufour P, et al.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePregnancy outcomes in women with sickle cell disease: A French multicenter cohort study. \u003cem\u003eHaematologica\u003c/em\u003e. \u003cstrong\u003e2021;106(3):793\u0026ndash;802.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003edoi:10.3324/haematol.2020.262601\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8886965/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8886965/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eHemoglobinopathies are the most common genetic defects globally, the majority of them are in sub-Saharan Africa and Southeast Asia. Hemoglobin C is a common hemoglobin variant although the prevalence of homozygous genotype CC (HbCC) is unknown. Approximately 28,000 infants are born annually with HbCC. HbCC is associated with intracellular hemoglobin crystallization with increased viscosity and reduced red blood cell life span. Although HbC is prevalent in much of sub-Saharan Africa, there is little data in the literature to address whether people with HbCC have clinical manifestations and even less is understood about this during pregnancy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study describes the clinical features of pregnant women with HbCC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eThis is a case series of all mothers who delivered at the University College Hospital between 2017 – 2023. All parturients had haemoglobin electrophoresis to determine their haemoglobin genotype in pregnancy. Women with hemoglobinopathies were identified and their case notes were retrieved.\u003cstrong\u003e \u003c/strong\u003eData was extracted from their case notes with the aid of proforma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Among the 11,496 deliveries over the study period, 180 (1.6%) had haemoglobinopathies and N (0.05%) had HbCC. The women with HbCC were aged 31 to 44 with a mean age of 35.7 years. Four (66%) of these women had previous deliveries. Two (33%) had their hemoglobin genotype diagnosed in childhood, others were diagnosed during their first pregnancy. The mean PCV was 27.7(±3.0)%, an they all had less than 33% which is the threshold for anemia diagnosis.\u003c/p\u003e\n\u003cp\u003eFour (two-thirds of them had blood transfusions at least once. Complications reported were bone pain (n=1), hypertensive disorders in pregnancy (n=1), and malaria (n=1). Four had caesarean delivery for obstetric indications or maternal request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eHbCC among parturients is rare. Anemia was prevalent among women with HbCC and, as expected, Although bone pain was reported in one of the six cases, there were no features of sickle cell disease among HbCC women. The majority underwent caesarean section for obstetric indications unrelated to their haemoglobin genotype.\u003c/p\u003e","manuscriptTitle":"Hemoglobin Cc in Pregnancy; a Case Series of 6-cases Managed Over 7 Years at the University College Hospital, Ibadan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-20 11:57:12","doi":"10.21203/rs.3.rs-8886965/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-20T13:17:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T06:50:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-04T00:06:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-28T17:12:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26042259771923357551226291194763805059","date":"2026-03-26T19:20:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142185335869135300986452265730636951023","date":"2026-03-25T13:57:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90763263567167098990877205220332633232","date":"2026-03-25T05:11:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102001719834402692825300156567620944568","date":"2026-03-23T13:26:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54251053387146618832294472343054029921","date":"2026-03-22T21:40:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113706058521516217436113662657252518671","date":"2026-03-22T17:32:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T05:20:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175862545186536707507055094544835963098","date":"2026-03-17T21:52:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-17T14:18:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-16T11:42:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-20T13:08:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-18T06:03:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-02-18T05:28:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a4adab67-a73b-4d4b-b658-2dec52ef5d13","owner":[],"postedDate":"March 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-10T21:23:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-20 11:57:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8886965","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8886965","identity":"rs-8886965","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}