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.
But because expectant moms with sickle cell disease are also more likely to experience certain health complications, your pregnancy likely will be classified as high risk.
Sickle cell disease is an inherited condition in which your body makes abnormal red blood cells that are sickle- (or "C-") shaped instead of round.
How does pregnancy affect sickle cell disease?
Moms-to-be with sickle cell disease are more likely to experience anemia and painful episodes during pregnancy than at other times.
A painful episode, sometimes called a sickle cell crisis, happens when misshapen blood cells block small blood vessels that carry blood to your bones.
You might feel dull, sharp or even throbbing pain in your back, legs, arms, chest or stomach. A sickle cell crisis can last several hours to several days and will vary in severity from person to person and crisis to crisis.
Doctors aren’t exactly sure why, but the added physical stress of pregnancy appears to increase the chances of having painful episodes, especially later in pregnancy.
If you have sickle cell disease, you’re more likely to have other health problems during pregnancy too, including infections and vision problems.
How does sickle cell disease affect pregnancy?
With sickle cell disease, you’ll have a higher risk of certain pregnancy complications, including miscarriage, preterm delivery and having a low-birth-weight baby.
High blood pressure and preeclampsia — a potentially dangerous pregnancy complication characterized by the sudden onset of high blood pressure — also are more common in women with sickle cell disease.
As far as childbirth is concerned, you’re slightly more likely than other mothers to have a C-section. That’s mostly due to the increased rate of pregnancy complications in women with sickle cell disease.
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Will I need special treatment during pregnancy?
Some women with sickle cell disease have too much iron stored in their blood — even when they are anemic. If you are one of these women, your doctor may recommend a prenatal vitamin that has no iron.
You 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 isn’t enough evidence yet to say this is definitively the case.
Your prenatal checkups may be more frequent than those of other moms-to-be. You may be asked to meet with your practitioner every two to three weeks during the second trimester and every week during the third trimester. In addition to routine prenatal monitoring, your practitioner may recommend additional blood tests to stay ahead of any potential complications that could occur.
If you take medications for your condition, be sure to ask your practitioner if you can continue taking them. Not all meds for sickle cell disease are safe during pregnancy.
For instance, your doctor may recommend that you stop taking hydroxyurea, a medication that helps prevent red blood cells from sickling (turning into a C-shape). Animal studies have suggested that hydroxyurea may lead to an increased risk of certain birth defects, though doctors haven’t yet found evidence of this in human babies.
You also may need to add medication to your routine. Women with sickle cell often are 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.
Your provider should be able to help you balance your treatment needs with a healthy pregnancy. But you can also learn about which medications are safe at MotherToBaby.org. Always get the green light from your doctor before making any changes to your treatment regimen.
Will my baby inherit sickle cell disease?
Sickle cell disease is a genetic condition, so it's 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 your pregnancy (if he wasn’t before conception). If he doesn’t carry the trait, there’s no chance that your baby will have sickle cell disease. If he turns out to be a sickle cell carrier, prenatal testing can help determine whether your baby is affected. A genetic counselor can help you understand the risk.
It's important to be in close, frequent contact with your practitioner about how best to manage your condition while you're pregnant and to speak up about any concerns you have along the way. With expert medical supervision and care, you can have a healthy pregnancy and baby even if you have sickle cell disease.
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