Sickle cell disease is one of the most common inherited red blood cell disorders, yet many are not aware of their carrier status (Treadwell, J Nat Med Assoc, 2006), which can lead to confusion around pregnancy and newborn diagnosis. Scott Moerdler, MD, a pediatric hematologist/oncologist, is part of the team at Rutgers Cancer Institute that manages the care of patients with sickle cell anemia. He and collaborators from other centers examined prenatal screening practices for blood disorders between different types of care providers and found different variations in prenatal guidance.
Results of the work are being presented at the American Society of Hematology Annual Meeting in Orlando this week. Dr. Moerdler, who is the lead investigator and an assistant professor of pediatrics at Rutgers Robert Wood Johnson Medical School, shares more about the work, which highlighted differences between obstetrics/gynecology practices and family medicine providers.
Q: Why is this topic important to explore?
A: The American College of Obstetricians and Gynecologists' guidelines recommend specific screening practices for pregnant women of certain backgrounds. However, adherence to this practice and frequency of improper screening is unknown. Screening differences can lead to variations in prenatal guidance, diagnostic testing, informed decision-making and knowledge of families referred to pediatric hematology clinics.
Q: Tell us about the work and what you and your colleagues found.
A: We found differences between OBGYN and family medicine prenatal providers in their self-reported practices of at risk patients as well as differences by ethnicity. Over a quarter of respondents report using inappropriate screening tests. We also found under utilization of referrals to hematology, as almost half of respondents would never refer at-risk couples to hematology.
Q: Why are these results significant?
A: This is the first survey analyzing prenatal screening for hemoglobinopathies in both OBGYN and family medicine. It highlights differences in the methods and likelihood of prenatal hemoglobinopathy screening based on the type of prenatal care provider and demonstrates that not all providers adhere to existing ACOG recommendations. Due to these differences and room for improved adherence to guidelines, this survey identifies an actionable area for enhanced education of prenatal providers on populations at risk that require screening and which screening modalities are most useful.
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