Health Guide for Sickle Cell Anemia and Pregnancy

Sickle Cell Anemia and Pregnancy

Sickle cell anemia (SCA) is a genetic blood disorder in which the red blood cells, which are usually round and elastic, become inflexible and crescent- or sickle-shaped. These deformed cells can obstruct blood flow, causing pain, damage to organs, and increased susceptibility to infections.

Sickle cell anemia and pregnancy is high-risk because the mother and the fetus are more likely to develop complications. Nevertheless, with close medical supervision and attention, most women with SCA can experience successful pregnancies.

Relationship between Sickle Cell Anemia and Pregnancy

Sickle cell anemia and Pregnancy are closely related since pregnancy increases the physical demand on the body, which can aggravate the complications of SCA. Conversely, Sickle cell anemia influences the success of a pregnancy with the way it affects blood circulation, oxygen supply, and organ function.

This compatibility indicates:

Elevated Physical Requirement during Pregnancy

• Pregnancy elevates blood volume, heart rate, and oxygen requirement.
• Red blood cells are already defective in carrying oxygen in sickle cell anemia.
• This worsens anemia and causes more frequent sickle cell crises (painful crises due obstructed blood vessels).

Vascular and Placental Complications

• Sickle cells are adhesive and tend to obstruct blood vessels.

During pregnancy, this can impair placental blood flow, causing:

• Poor oxygen and nutrient supply to the fetus
• Risk of miscarriage, stillbirth, or intrauterine growth restriction (IUGR)

Decreased Immune Function and Infection

• Sickle Cell Anemia and Pregnancy both compromise the immune system.
• SCA women, who are pregnant, are at higher risk for infections (e.g., UTIs, pneumonia) that can initiate crises or cause preterm labor.

Complications Such as Preeclampsia and Blood Clots

• SCA raises the risk of hypertension and preeclampsia.
• The disease also raises the risks of clotting, and pregnancy already thins the blood, making it more susceptible to clots — doubling the threat.

Genetic Link

• SCA is hereditary. An expectant mother with SCA can transmit the gene to the child.

If both parents have the sickle cell trait, there's a:

• 25% chance the child will have sickle cell anemia

• 50% chance the child will have the trait

• 25% chance the child won't be affected

Sickle cell disease and pregnancy management

Sickle Cell Disease (SCD) and Pregnancy Management is best managed using a multidisciplinary team because of the added risks to both the fetus and mother. Below is an organized outline:

Overview of SCD in Pregnancy

• Sickle Cell Disease is a hemoglobin genetic disorder that results in the sickling, vaso-occlusion, hemolytic anemia, and organ damage of red blood cells.
• Pregnancy augments complications because of physiologic stress, hypercoagulability, and immune suppression.

Pregnancy risks with sickle cell anemia

Pregnancy Complications in Sickle Cell Anemia are much greater than in the general population because of the chronic disease complications and higher physiological demands of pregnancy. This is a structured summary:

Maternal Pregnancy Complications in Sickle Cell Disease:

Vaso-occlusive crises (VOCs)

• Hypoxia-, dehydration-, infection-, or stress-induced painful episodes; more common in pregnancy.

Acute Chest Syndrome (ACS)

• Life-threatening condition with chest pain, fever, and hypoxia; usually precipitated by infection or embolism.

Severe Anemia

• Secondary to chronic hemolysis; can necessitate recurrent transfusions.

Infections

• Functional asplenia leads to increased risk of UTIs, pneumonia, and sepsis.

Preeclampsia/Eclampsia

• Increased risk of hypertensive disorders of pregnancy.

Thromboembolism

• Increased risk secondary to hypercoagulability of pregnancy and SCD.

Pulmonary Hypertension

• Can worsen during pregnancy and contribute to increased maternal mortality.

Stroke

• Increased risk secondary to vaso-occlusion and anemia.

Maternal Mortality

• 2–10 times that of the general population in some areas.

Fetal Risks in Pregnancy with Sickle Cell Anemia:

Intrauterine Growth Restriction (IUGR)

• Placental insufficiency caused by sickling in placental vessels.

Preterm Labor and Birth

• Frequently caused by maternal disease or iatrogenic induction.

Low Birth Weight

• Frequent in SCD pregnancies.

Miscarriage

• Increased risk, especially in poorly controlled disease.

Stillbirth

• Increased because of fetal hypoxia and placental infarctions.

Neonatal Death

• Risk increased particularly in low-resource settings.

Sickle cell anemia and pregnancy guidelines

Below are the official pregnancy management guidelines for women with Sickle Cell Anemia (SCA), according to prominent international recommendations like those of the Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynaecologists (ACOG), and WHO:

Sickle Cell Anemia and Pregnancy Guidelines:

Preconception Care

• Genetic counselling for the patient and her partner to determine risk of fetal sickle cell disease.
• Screen the partner for other hemoglobinopathies (HbAS, HbC, etc.).
• Check for baseline complications: renal, cardiac, liver function, pulmonary hypertension.
• Initiate high-dose folic acid (4–5 mg/day).
• Update vaccination status: pneumococcal, meningococcal, H. influenzae, hepatitis B, influenza.

Antenatal Care

• Multidisciplinary team management: obstetrician, hematologist, anesthetist, pediatrician.
• Increase frequency of antenatal visits (monthly to bimonthly in third trimester).

Watch for:

• Hemoglobin levels
• Urinary tract infections
• Fetal growth (serial ultrasounds at 4-weekly intervals from 24 weeks)
• Educate on prevention of triggers (dehydration, cold, infection, overexertion).
• Administer low-dose aspirin (75–150 mg/day) from 12 weeks to lower preeclampsia risk.

Prescribe prophylactic blood transfusions in:

• Severe complications in the past
• Recurrent VOCs
• Previous bad pregnancy outcome
• Use iron supplements only if iron deficiency is established (not routine).
• Pain management: paracetamol first line; opioids if necessary; NSAIDs avoided in late pregnancy.
• Infection prevention: treat promptly, urine culture every trimester.

Intrapartum Care

• Delivery planned at a tertiary care facility.
• Vaginal delivery to be preferred except when obstetric reasons for cesarean.

Ensure:

• Proper hydration
• Oxygen therapy if hypoxic
• Pain relief by epidural analgesia
• Continuous fetal monitoring
• Avoid prolonged labor, hypoxia, and acidosis.
• In high-risk cases, consider prophylactic blood transfusion prior to delivery.

Postpartum Care

• Resume hydration and oxygen support as required.

Closely monitor for:

• VOCs
• Infections
• Postpartum hemorrhage
• Thromboembolic events
• Institute thromboprophylaxis with LMWH for 7 days after delivery (longer in the case of cesarean or immobility).
• Encourage early ambulation.
• Breastfeeding should be encouraged (safe in most pain medications and folic acid).

Discuss contraception:

• Avoid combined estrogen contraceptives in high-risk women
• Use progestin-only pills, IUDs, or implants

Special Considerations

• Avoid hydroxyurea use in pregnancy and lactation because of teratogenic risk.
• Avoid NSAIDs in 3rd trimester because of risk of premature closure of the ductus arteriosus.
• Be vigilant for acute chest syndrome, preeclampsia, or fetal compromise.

Sickle cell disease pregnancy outcomes

Pregnancy in women with Sickle Cell Disease (SCD), especially homozygous HbSS, is high-risk because it has much higher levels of maternal, fetal, and neonatal complications in comparison to the general population.

Adverse Maternal Outcomes:

Vaso-occlusive crises (VOCs)

• Increased due to elevated metabolic demand and changes in blood volume.

Acute chest syndrome (ACS)

• One of the most common causes of maternal death in SCD pregnancies.

Severe anemia

• Prevalent due to hemolysis; may need to be transfused.

Preeclampsia/Eclampsia

• Incidence much higher than in non-SCD pregnancies.

Infections

• Increased risk of urinary tract infections, pneumonia, and sepsis.

Venous thromboembolism (VTE)

• Pregnancy and SCD are pro-thrombotic conditions.

Pulmonary hypertension, stroke, or heart failure

• May exacerbate during pregnancy, with a rise in maternal mortality.

Maternal mortality

• Up to 10-fold higher in low-resource environments.

Poor Fetal and Neonatal Outcomes:

Intrauterine Growth Restriction (IUGR)

• Attributed to placental infarctions due to vaso-occlusion.

Low birth weight (<2.5 kg)

• Observed in up to 40–60% of SCD pregnancies.

Preterm birth (<37 weeks)

• Usually because of maternal complications or medical indication for delivery.

Stillbirth

• Placental insufficiency and maternal disease raise the risk.

Spontaneous abortion

• Increased rate of first-trimester miscarriage.

Perinatal and neonatal death

• Increased, especially in those with poor neonatal care.

Apgar score <7 at 5 minutes

• With neonatal complications.

Managing sickle cell anemia during pregnancy

Sickle cell anemia (SCA) management during pregnancy is a multidisciplinary, proactive, and individualized process aimed at optimizing maternal and fetal outcomes. The aim is prevention of complications, observation of maternal and fetal health, and safe delivery.

Preconception and Early Pregnancy Care

Preconception Counselling

• Genetic testing and partner screening to determine fetal risk.

Baseline Evaluation

• Complete blood count, hemoglobin electrophoresis, liver/renal function, cardiac and pulmonary evaluation.

Folic Acid

• 4–5 mg daily to enhance production of red blood cells.

Vaccination Update

• Pneumococcal, meningococcal, H. influenzae, hepatitis B, influenza.

Discontinue Teratogens

• Discontinue hydroxyurea and other contraindicated medications prior to conception.

Antenatal Management

General Monitoring

• Multidisciplinary Team: Obstetrician, hematologist, anesthetist, pediatrician.
• Frequent Antenatal Visits: Every 2–4 weeks; more frequently in third trimester.
• Serial Ultrasounds: Document fetal growth every 4 weeks from 24 weeks.

Maternal Monitoring

• CBC, reticulocyte count, LFTs, RFTs every 4–6 weeks.
• Screen for infections regularly (especially UTIs).
• Avoid triggers: cold, dehydration, stress, overexertion.

Medications & Supplements

Folic acid

• 4–5 mg daily during pregnancy.

Iron

• Only if iron deficiency is diagnosed (not routine because of risk of iron overload).

Low-dose aspirin (75–150 mg)

• Begin at 12 weeks to prevent preeclampsia.

Relief from pain

• Paracetamol first choice; opioids if necessary. In late pregnancy, avoid NSAIDs.

Transfusion Strategy

Indicated for:

• Symptomatic anemia (Hb <7 g/dL)
• Frequent vaso-occlusive crises
• Acute chest syndrome
• Prevention of stroke
• Prophylactic transfusions can be considered in serious cases or past adverse pregnancy outcome.

Management of Acute Complications

Vaso-occlusive crisis (VOC)

• Hydration, oxygen, analgesics, rest; treat precipitants (e.g. infection).

Acute chest syndrome

• Emergency hospitalization, oxygen, antibiotics, transfusion.

Severe anemia

• Packed red cell transfusion.

Infections

• Prompt antibiotics, particularly for UTI or resp infection.

Preeclampsia

• Treat per obstetric protocol; delivery in severe cases or at or near term.

Intrapartum Care

Delivery Planning

• At 37–39 weeks if stable. Earlier with complications.

Preferred Mode

• Vaginal delivery unless obstetric need for cesarean.

Monitoring

• Continuous fetal heart rate monitoring.

Pain Relief

• Epidural is safe and preferred.

Hydration and Oxygen

• Continue IV fluids and oxygenation through labor.

Postpartum Care

Watch for VOCs or ACS

• Particularly in the first 72 hours postpartum.

Thromboprophylaxis

• LMWH for 7 days after vaginal, 6 weeks after cesarean or high-risk.

Encourage Breastfeeding

• Safe even on opioids or most medications.

Early Ambulation

• To decrease risk of thrombosis.

Contraception Counselling

• Progestin-only pills, implants, or IUDs. Avoid estrogen pills if risk of thrombosis.

Blood Cross-match

• Have blood available in case of transfusion risk.

Sickle cell anemia and fetal health

Pregnancy in a woman with sickle cell anemia (SCA) is risky to the health of the fetus because of maternal complications such as anemia, vaso-occlusion, and placental insufficiency. These impair oxygen and nutrient delivery to the fetus, which influences growth and survival.

How Sickle Cell Anemia Affects the Fetus?

Placental vaso-occlusion

• Decreased blood flow leads to intrauterine growth restriction (IUGR).

Chronic maternal anemia

• Triggers fetal hypoxia, impaired growth, and enhanced distress.

Increased maternal infections

• May cause preterm labor or fetal loss.

Sickling in placental vessels

• Results in placental infarction, diminishing nutrient exchange.

Acute maternal complications (e.g. VOCs, ACS)

• Can lead to precipitating fetal hypoxia, stillbirth, or preterm delivery.

Sickle cell anemia and pregnancy treatment options

Management of sickle cell anemia and pregnancy is aimed at preventing and treating complications, enhancing maternal health, and promoting optimal fetal outcomes. Management is supportive, preventive, and tailored, depending on maternal status and pregnancy duration.

• Supportive Therapy
• Blood Transfusions
• Drug Management
• Prevention and Management of Infections
• Fetal Monitoring and Surveillance
• Intrapartum and Delivery Management
• Postpartum Care

Sickle cell anemia and maternal health in pregnancy

Pregnancy in patients with major Sickle Cell Anemia (SCA) is complicated by the underlying chronic hemolytic anemia, vascular impairment, and common vaso-occlusive events. These maternal morbidities are magnified by the physiologic changes of pregnancy, elevating morbidity and mortality.

Effect of Pregnancy on Maternal Health with Sickle Cell Anemia

Increased cardiac output and blood volume

• Worsens initial anemia

Immunosuppression

• Increases susceptibility to infections

Hypercoagulability

• Augments thrombotic risks (DVT, PE)

Decreased oxygen carrying capacity

• Augments risk of tissue hypoxia and VOCs

Hormonal changes and placental requirements

• May initiate crises and complications

Sickle cell anemia and pregnancy care plan

Preconception

• Genetic counselling (partner screening)
• Discontinue hydroxyurea
• Initiate folic acid 4–5 mg/d
• Update immunizations

Antenatal Care

• Multidisciplinary team (OB, hematology, anesthesiology)
• Monthly visits → biweekly in 3rd trimester
• Serial ultrasounds (q4 weeks from 24 weeks)
• Follow CBC, LFTs, RFTs, urine culture
• Low-dose aspirin (75–150 mg/day from 12 weeks)
• Transfusions if Hb <7 g/dL or frequent VOCs
• Infection screen and treatment
• Pain: Paracetamol ± opioids (avoid NSAIDs late pregnancy)

Intrapartum Care

• Delivery planned at 37–39 weeks in tertiary center
• IV fluids, oxygen, pain relief (epidural ideal)
• Continuous fetal monitoring
• Cross-matched blood preoperatively

Postpartum Care

• Thromboprophylaxis with LMWH (7–42 days)
• Watch for VOCs, infection
• Breastfeeding support
• Family planning: IUD or progestin-only contraceptive

Sickle cell anemia and labor and delivery

Women with sickle cell anemia (SCA) are at risk of increased threats to both themselves and their infants during labor and delivery from the effects of anemia, vaso-occlusion, and organ dysfunction. Careful planning and support are necessary to provide safe outcomes for both mother and infant.

Most Important Objectives During Labor and Delivery

• Avoid sickling crises
• Provide oxygenation and hydration
• Provide pain control
• Monitor fetal distress
• Prepare for emergencies

Sickle cell anemia and breastfeeding

Breastfeeding is not only safe but also highly recommended for sickle cell anemia (SCA) patients. The majority of drugs employed in SCA treatment are safely used during breastfeeding, and advantages should supersede any risk when adequately supervised.

Can Women with Sickle Cell Anemia Breastfeed?

Yes. SCD in itself is not a contraindication for breastfeeding. Breastfeeding provides:

• Immune and nutritional advantages for the infant
• Emotional attachment
• Natural contraception assistance in early postpartum (lactational amenorrhea)

Sickle cell anemia genetic counselling during pregnancy

Genetic counselling is an essential aspect of prenatal management in couples in which one or both the partners are HbAS bearers or HbSS anemic patients. It is useful in informing parents about the risk of inheritance, availability of tests, and reproductive decisions.

Objectives of Genetic Counselling during Pregnancy

• Evaluate fetal risk of inheriting SCD
• Educate the couple regarding patterns of inheritance and prognosis
• Explain testing possibilities: prenatal and preimplantation genetic diagnosis (PGD)
• Support informed decision-making (emotional, ethical, and medical considerations).

Why Choose GetWellGo for Sickle Cell Anemia and Pregnancy?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for sickle cell anemia and pregnancy.
• Expert doctor with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food

Case Study of Courage: Pregnancy with Sickle Cell Anemia Managed with GetWellGo

• Patient Name: Achieng’ Mary Odhiambo.
• Age: 28 years old
• Gender: Female
• Country of Origin: Kenya
• Name of the doctor: Dr. Vikas Dua and Multidisciplinary Team
• Name of the Hospital: Fortis Memorial Research Institute, Gurgaon
• Treatment: Pregnancy Care and Sickle Cell anemia treatment

This is what happened to one of the 28 years Kenyan women known as Achieng’ Mary Odhiambo. who was already living with sickle cell anemia and had to deal with her health in addition to being a pregnant woman. The condition was quite dangerous to not only her but also to her unborn baby. She had frequent pain crises, fatigue and reduced immunity, and her pregnancy was considered to be at high-risk, which is why her family sought the high-tech solutions in other countries.

The family initially discovered the platform GetWellGo through thorough research and referral and was guided towards special care in India. GetWellGo international patient services arranged the whole process of medical traveling, including picking up and accommodating at the airport and seeing Fortis Memorial Research Institute as one of the top hospitals in Gurgaon, which had to be given priority.

In Fortis, Odhiambo was admitted and was taken care of by Dr. Vikas Dua, one of the senior pediatric hematologists, a multidisciplinary team comprising obstetricians, hematologists, and maternal-fetal medicine specialists. The team also collaborated to develop a tailor-made treatment plan which considered both her management of sickle cell and pregnancy.

Through close observation, high-end drugs, and supportive blood transfusion where needed, the state of Odhiambo was maintained during the course of pregnancy. Regular check-ups, nutritional advice, and pain management therapies were administered to her to reduce sickle cell crises. The tight cooperation between the hematology and obstetrics kept both the mother and the baby safe at all times.

Odhiambo had to undergo months of intensive care and follow-ups but at the end of it all, she was able to give birth to a healthy baby. She was still being followed up on recovery after delivery, and the emphasis was on reducing the complications and assisting her in long term health care.

In her speech Achieng’ Mary Odhiambo shared her gratitude:

The idea of carrying a pregnancy with a sickle cell anemia was intimidating, yet with the help of Dr. Vikas Dua, his staff, and the support of GetWellGo all the time, I felt safe throughout the process. The attention and synchronization I received made all the difference. I am a blessed woman today with a healthy child and the strength to go on with my life with a fresh hope.

We congratulate Odhiambo on her bravery and strength and wish her whole heartedly for her health and happiness and be well with her baby.