A woman with sickle cell disease is more likely to have problems during pregnancy that can affect her health and the health of the unborn baby, compared to a woman without sickle cell disease. Several studies have shown that early prenatal care, and careful monitoring throughout pregnancy, can result in a woman with sickle cell disease having a healthy pregnancy.
What is Sickle Cell Disease?
Sickle cell disease is the name for a group of inherited health conditions that affect the red blood cells. The most serious type is called sickle cell anaemia.
Sickle cell disease is a recessive condition, which means that both parents must pass on the sickle cell gene for a child to be born with sickle cell disease. Sickle cell disease is the most common inherited condition worldwide.
Sickle cell disease can occur in a number of races, but is particularly common in people with an African or Caribbean family background.
People with sickle cell disease produce unusually shaped red blood cells that can cause problems because they do not live as long as healthy blood cells – and can block blood vessels. Sickle cell disease is a serious and lifelong health condition, although treatment can help manage many of the symptoms.
Sickle cell disease and pregnancy
Thanks to major medical advances, most women with sickle cell disease — even those who have heart or kidney complications — can have a healthy pregnancy, and delivery, provided certain measures are taken. Due to an increased risk of complications, women who have sickle cell disease and become pregnant are classified as high risk.
Sickle cell disease is associated with both maternal and fetal complications, and is associated with an increased incidence of perinatal mortality, premature labour, fetal growth restriction and acute painful crises during pregnancy.
Some studies also describe an increase in spontaneous miscarriage, antenatal hospitalisation, maternal mortality, delivery by caesarean section, infection, thromboembolic events and antepartum haemorrhage.
Do pregnant women with sickle cell disease need special treatment during pregnancy?
Some women with sickle cell disease have too much iron stored in their blood — even when they are anaemic. In these cases your obstetrician would recommend prenatal vitamins without iron.
Affected women may receive one or more blood transfusions at some point during pregnancy. Some experts believe that prophylactic blood transfusions may reduce painful episodes and lung complications in women with sickle cell disease, though there is not enough evidence yet to say this is definitively the case.
Women with sickle cell disease who are pregnant should have more frequent prenatal checkups. In addition to routine prenatal monitoring, your obstetrician may recommend additional blood tests to stay ahead of any potential complications that could occur.
Pregnant women with SCD may need to add medications to their routine medications. Women with sickle cell are often prescribed low-dose aspirin after the first trimester. This will help to lower your risk of blood clots — which is more common in women with sickle cell disease.
Will your baby inherit sickle cell disease?
Sickle cell disease is a genetic condition, so it is possible that your baby could inherit it. The likelihood of that happening depends on whether your partner also carries the gene.
The baby’s father should be tested for the trait early in the pregnancy (if it was not done before conception). If he does not carry the trait, there is no chance that your baby will have sickle cell disease. If he turns out to be a sickle cell carrier you might benefit by seeing a genetic counsellor who will help you understand the risk.
It is important that all pregnant women who have sickle cell disease – to be in close, frequent, contact with their obstetrician about how best to manage their condition and to speak up about any concerns they have along the way. With expert medical supervision and care, most women with sickle cell disease can have a healthy pregnancy and baby.
Conclusion
Women who have sickle cell disease in pregnancy should be under the care of an experienced obstetrician, and should be managed by a team of medical professionals to ensure that most of the complications associated with this inherited disorder can be prevented, or treated appropriately so that there is a successful pregnancy. Several studies have shown that sickle cell disease does affect pregnancy – and pregnancy also exacerbates some signs and symptoms of sickle cell disease.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field is ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
