Women's Health

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Sickle Cell Anemia and Pregnancy

Overview:

Women suffering from sickle-cell anemia (SCA) can still get pregnant normally. A woman who has pregnancy plans, however, will have to consult with the doctor beforehand, to reduce the possibility of developing complications. It is also important to know whether the spouse is affected by the disease, in order to assess the risk of having a baby with sickle-cell anemia too.

Pre-pregnancy mandatory tests:

Full clinical screening;
Blood pressure examination, and close follow-up thereof;
Blood tests, especially hemoglobin test;
Cardiography and echocardiography (heart sonar);
Renal function test, and urine protein test;
Retinal examination by a specialist.

Treatment during pregnancy:

SCA patients are often at greater risk of bacterial infections; which means they are often in need of taking antibiotics. Therefore, it’s important to consult your doctor if you are planning for pregnancy, to make sure that such medications do not affect pregnancy.
If you take Hydroxyurea on a regular basis, for example, you should stop taking it three months before pregnancy, or as soon as you are aware of it. Ask your doctor for safe alternatives.
Take a high dose of folic acid (5mg daily) throughout pregnancy to strengthen blood cells.
Take a low dose of aspirin (75mg daily) throughout pregnancy to reduce the risk of toxaemia of pregnancy.
You can take painkillers (e.g. Paracetamol).
Avoid some painkillers (e.g. Ibuprofen) which may affect the fetus.

Risks to the mother and baby:

Pregnant women suffering from sickle cell anemia are at a higher risk of giving birth to premature or underweight babies. Most of them, however, can have healthy children if they are properly monitored and guided before, during and after pregnancy.
Sickle cells may cause frequent pain episodes during pregnancy, especially when the precautions to avoid pain triggers are not taken. Such triggers include cold weather, rigorous physical activity, and dehydration.
During the later stages of pregnancy, you may experience eclampsia or spasms (owing to hypertension and proteinuria).
During the last months of pregnancy, the pregnant woman becomes at higher risk of suffering from thoracic outlet syndrome (TOS). Go to the nearest hospital if you have difficulty breathing or experience chest pains.

Fetus health tests:

Amniotic fluid test: This test is conducted between the 15th and 18th weeks of pregnancy.
A small sample is taken from the placenta to conduct a DNA test between the 10th and 12th weeks of pregnancy.
A blood sample is taken from the umbilical cord during the 16th week of pregnancy.

Whether to undergo these tests remains the mother's choice to make; since they involve a low risk of miscarriage.

Medical care during pregnancy:

Check the expiry date of annual vaccines (e.g. hepatitis B, influenza, pneumonia).
Make sure to visit the doctor on a weekly basis after the 24th week of pregnancy, till the delivery date. You will undergo general examinations as well as other specific tests (e.g. blood pressure, urinoscopy, fetal growth).
Blood transfusions are not usually necessary for patients with sickle-cell anemia, but if necessary, it will be discussed with the patient.

Additional medical care:

A blood clotting risk assessment (deep vein thrombosis in the legs or lungs) should be conducted in an early stage of pregnancy in case a risk factor (e.g. obesity) exists.
Heparin injections, a safe treatment, may be prescribed throughout pregnancy and must continue for 6 weeks after delivery.

Labor and delivery:

Childbirth must take place in a hospital to limit the risk of developing complications.
The necessary blood transfusion units shall be made available to be used if/when needed.
The heart rate of the fetus shall be closely monitored during labor.
In case a C-section is required, an anesthesiologist should be consulted before delivery, to discuss the pain-alleviation options.
It is usually advised to conduct a blood transfusion before the C-section, especially when hemoglobin levels are low.

Breastfeeding:

Breastfeeding does not pose any risk to the mother or the baby. On the contrary, breastfeeding is encouraged.

Contraception:

SCA patients are advised to use a contraception method such as:

Progesterone pills, Depo-Provera injections, birth control implant, hormonal IUD, condoms.
Estrogen pills and copper IUDs may be used only if the above-mentioned methods prove to be inappropriate.