In this article:
What Is Sickle Cell Disease, and Why Does It Matter in Pregnancy?
Sickle cell disease is a genetic disorder that results in abnormalities in red blood cells by causing them to assume a sickle shape rather than their normal disc shape. The cells live shorter lives, are more likely to cause obstructions, and transfer oxygen less effectively. Oxygen needs tend to be higher in pregnancy and will create more strain in cases of sickle cell disease, necessitating close monitoring of pregnancies in such patients.
Effects of Sickle Cell Disease in Pregnancy
Women and the baby can both be affected by sickle cell disease.
Mother's Risks:
- Sickle Cell Crisis: You will find that you get more painful episodes during pregnancy. This may be due to increased stress on your system due to pregnancy, dehydration or hormonal changes.
- Anaemia: Red blood cells in sickle cell disease have a shorter lifespan than normal, and during pregnancy, they need to work even harder to provide oxygen to the body, exacerbating anaemia.
- Infections: Particularly chest and urinary tract infections (UTIs), can lead to complications.
- Pre-eclampsia: You are at higher risk of developing this serious high blood pressure complication.
- Blood Clots: The risk is higher during pregnancy anyway, and even more so with sickle cell disease.
- Acute Chest Syndrome: A serious lung complication that may arise during pregnancy.
Baby's Risks:
- Preterm birth
- Low birth weight
- Stillbirth
- Inheritance of sickle cell disease
Why Is Pre-Conception Care So Important?
It is important that if you have sickle cell disease and are hoping to become pregnant, you discuss preconception planning with your specialist. Medical recommendations generally involve:
- Reviewing current medications.
- Genetic counselling to understand the risks you will pass to your child.
- Partner testing to assess any risk of inheritance for the baby.
- Optimisation of pre-pregnancy health (e.g., iron levels, folic acid levels and vaccination status).
- Consultation with both haematology and obstetrics specialities.
How to Manage Sickle Cell Disease Throughout Pregnancy?
Here are a few recommendations:
- Folic acid supplements
- Checkups and monitoring
- Blood transfusion
- Hydration
Labour and Delivery With Sickle Cell Disease
Delivery needs to take place in a hospital that is well equipped to manage patients with sickle cell disease, and neonatal care facilities should be available. Your doctor will discuss the risks with you, and there are considerations about the mode of delivery according to the individual. You will need to stay well hydrated, oxygen levels will be carefully monitored, and your pain management will be key. The fetus will be monitored continuously.
When to Contact Your Doctor?
Go to the hospital or seek immediate medical attention if you develop:- Sudden or severe pain in any of the limbs, the chest, the abdomen or the back.
- Breathlessness or shortness of breath.
- A high fever or if you start to shiver.
- Severe headache or visual problems.
- Reduced baby movements.
- Excessive or sudden swelling of any parts of the body, for instance, your feet, hands or face.
- Pale or yellowish skin may indicate a worsening of your anaemia.
- If you are unsure if any of your medications are safe to take during pregnancy, you must consult your physician.
Never attempt to manage a sickle cell crisis on your own while pregnant, as your and your baby's well-being rely on immediate medical care.
Pregnancy in sickle cell disease demands careful preparation, a specialist team of doctors and nurses, and continuous monitoring-but having a safe and healthy pregnancy is certainly achievable. Preparation before you even conceive, having the necessary vitamins prescribed, attending your regular appointments and knowing when you must seek immediate help are the cornerstones of managing pregnancy in sickle cell disease. Make sure you have both a haematologist and an obstetrician managing your pregnancy; never be afraid to voice a concern, however trivial it might seem.
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FAQs on Pregnancy with Sickle Cell Disease: What to Know, on World Sickle Cell Awareness Day
- Can women with Sickle Cell Disease have a healthy pregnancy?
Yes, many women with sickle cell disease have perfectly healthy pregnancies and healthy babies, with adequate medical management. This is dependent on receiving early care and treatment from doctors and having a multidisciplinary team caring for you that should consist of a haematologist and an obstetrician. - Is my baby going to have Sickle Cell Disease if I have the disease?
Whether or not your baby will have sickle cell disease is dependent on whether their father also carries the sickle cell gene. If you alone carry the sickle cell gene, then it is likely your baby will be a carrier for sickle cell disease. However, if both you and your partner are carriers for the gene, then there is a 1 in 4 chance that your baby will have sickle cell disease. - Should I stop taking hydroxyurea when I become pregnant?
It is not recommended that you take hydroxyurea while pregnant, as it affects the developing baby. You are not advised to just stop taking the tablets, as this can lead to other problems. You need to contact your haematologist when you become pregnant while you are already taking hydroxyurea, so that they can advise you to stop taking it appropriately and manage the condition to prevent sickle cell crises.