Pregnancy and Sickle Cell Anemia
I have sickle cell anemia but my partner does not. We are
considering having a child and would like to know the risks of
conceiving under these circumstances.
For a woman with sickle cell anemia who is interested in having
children, it is ideal that she pursues supportive counseling and
healthcare before she conceives. She needs both a high-risk
obstetrician and a hemotologist. If the pregnancy is a surprise, she
should seek medical attention as soon as she suspects she might
Women who are pregnant with sickle cell have more frequent
sickle cell crises due to the extra stress of pregnancy. A sickle
crisis will occur in about a third of pregnancies. Pregnancy is an
intense burden on a woman's body, and this incredible strain can
easily exacerbate the sickling of red blood cells. When these cells
cluster together, they can build up in various organs throughout the
body, leading to intense pain. Furthermore, because blood vessels
can become blocked from all the cells, body tissues may be
deprived of their oxygen and can die. When this happens, the
body's first response is to send blood to be most important organs
in the body in order to survive and the uterus isn't one of them, so if
a woman is pregnant, her sickle cell anemia can deprive her fetus
of oxygen and nutrients.
The pregnancies are at higher risk of spontaneous abortion,
premature labor, pseudo-toxemia and cesarean section. The
fetuses are more likely to have growth lags, and more trouble with
the stresses of labor and delivery. After the birth, all women are
more likely to have infections and blood clots, but the risk for sickle
cell mothers is even greater.
But don't worry too much. There's lots you and your doctor can do
to prevent and correct these problems. Pregnant women with
sickle cell are almost always anemic at the first pre-natal visit.
Folic acid is given routinely. This is just the same as in non-sickle
cell pregnancies, it is simply more important in sickle cell
pregnancies. The norm of giving iron supplements to pregnant
women should not be followed without lab testing to show that is
indicated. Sickle cell patients may be overloaded with iron
because of frequent past transfusions. Morning sickness poses
extra risks for women with sickle cell. Morning sickness can lead to
dehydration and dehydration causes sickle cell crisis. Tests for
urinary tract infection will be done at each pre-natal visit, as women
with sickle cell are at increased risk for infection.
At the first visit, a pregnant woman with sickle cell should have the
following tests: complete blood count, reticulocyte count,
hemoglobin electrophoresis (for her partner as well), liver function
tests, hepatitis B and C, blood group and antibody typing, rubella
antibodies, syphilis test.