Women with sickle cell disease (SCD) are at an increased risk of several complications during pregnancy, both obstetrical and medical. If you have SCD, you will require coordinated multidisciplinary care and close follow-up during pregnancy. In pregnancy, patients with SCD are at an increased risk of thrombosis (blood clots), infections, pulmonary complications, sickle crises, and stroke. Additionally, they are at an increased risk of intrauterine growth restriction (IUGR), preeclampsia, abruption and preterm birth.
Pre-Pregnancy or Initial Appointment
Before (ideally) or right after conception, women with SCD should be evaluated for hypertension, cardiac function, pulmonary function, renal disease, retinopathy, and anemia, which are common. Women should also undergo an antibody screen for alloimmunization. Additionally, their partner should be tested for hemoglobinopathy, with genetic counseling as needed for a positive screen. Finally, patients should always be up-to-date on recommended vaccinations.
During their first trimester, supplemental folic acid is recommended up to 5 mg a day. Although most patients are anemic, they do not require iron supplements, since they are usually not iron deficient. Initial baseline testing is recommended, including an echocardiogram, pulmonary function testing, retinal exam, monthly CBC’s, and a baseline 24-hour urine collection and monthly urine cultures.
In most cases, low-dose aspirin is suggested due to the increased risk of thrombosis and preeclampsia. Pregnant women with SCD should be very careful to not become dehydrated, which includes a critical treatment of vomiting during the first trimester. Serial ultrasounds will also be performed to assess fetal growth and well-being.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!