WHO recommendations on the management of sickle-cell disease during pregnancy, childbirth and the interpregnancy period

Pregnancy represents a profound journey for any woman, but for those living with sickle cell disease (SCD), this path carries unique challenges and considerations. SCD affects millions worldwide, with pregnant women facing heightened risks of maternal mortality, pregnancy complications, and adverse fetal outcomes. The intersection of this inherited blood disorder with the physiological demands of pregnancy creates a complex clinical scenario requiring specialized care and vigilant management.

For healthcare providers and expectant mothers navigating this terrain, clear guidance is essential. The World Health Organization’s recommendations provide a crucial roadmap for managing SCD throughout the reproductive journey—from preconception planning through pregnancy and beyond. With proper medical attention and evidence-based protocols, women with SCD can experience safer pregnancies and healthier outcomes for both mother and child. 💪🩸

In this comprehensive guide, we’ll explore the full spectrum of care for pregnant women with SCD. From understanding the fundamental challenges of SCD in pregnancy to specific recommendations for preconception, antenatal care, medication management, and delivery considerations, we’ll outline the strategies that can transform this high-risk situation into a journey of hope and possibility. Join us as we delve into these critical WHO recommendations that are changing the landscape for expectant mothers with sickle cell disease.

Understanding Sickle Cell Disease in Pregnancy

Understanding Sickle Cell Disease in Pregnancy

Sickle cell disease (SCD) is an autosomal recessive hemoglobin disorder affecting approximately 7.74 million people globally. This genetic condition is particularly prevalent in sub-Saharan Africa and regions historically endemic to malaria, including parts of the Middle East, the Caribbean, and South Asia. For women with SCD, pregnancy introduces unique challenges that require specialized care and management to ensure optimal outcomes for both mother and baby.

Physiological changes during pregnancy for women with SCD

Pregnancy creates significant physiological demands on the body, which can exacerbate the underlying complications of sickle cell disease. During pregnancy, women experience:

• Increased metabolic demands that can strain already compromised systems
• Changes in blood volume and circulation that may trigger SCD-related complications
• Heightened risk for vaso-occlusive crises due to pregnancy-related stress on the body
• Potential exacerbation of chronic conditions associated with SCD

These physiological changes can lead to serious complications, including acute chest syndrome, which is characterized by chest pain, fever, and pulmonary infiltrates. The body’s increased oxygen demand during pregnancy places additional stress on women with SCD, whose red blood cells already have compromised oxygen-carrying capacity.

Furthermore, pregnancy may trigger fertility-related challenges for women with SCD. Research indicates that these women may experience delayed sexual development and fertility issues linked to factors such as hypogonadotropic hypogonadism and oxidative stress, which can affect reproductive function.

Risk factors and complications for mother and baby

Pregnant women with sickle cell disease face significantly higher risks of maternal and perinatal morbidity and mortality compared to the general population. Key complications include:

Maternal Complications:

• Increased risk of pre-eclampsia
• Higher incidence of vaso-occlusive crises
• Greater likelihood of acute chest syndrome
• Increased susceptibility to infections
• Higher rates of maternal mortality, particularly in low-resource settings

Fetal and Neonatal Complications:

• Intrauterine growth restriction (IUGR)
• Preterm labor and delivery
• Low birth weight
• Increased perinatal mortality rates
• Potential developmental impacts due to maternal complications

The disparities in outcomes are particularly stark between high-income and low-income regions, with sub-Saharan Africa showing significantly higher rates of complications due to limited healthcare access and resources.

Importance of pre-conception counseling and planning

Given the substantial risks associated with SCD during pregnancy, pre-conception counseling and planning are vital components of care. These services provide:

• Genetic counseling for patients and their partners to assess the risk of SCD in offspring
• Comprehensive health assessments, including blood tests and evaluations of previous SCD-related complications
• Education about the potential risks and complications during pregnancy
• Discussion of medication management, particularly regarding hydroxyurea, which is recommended to be discontinued prior to conception due to potential teratogenic effects
• Information about prenatal diagnostic options, including chorionic villus sampling and preimplantation genetic diagnosis for couples at risk

Pre-conception planning enables women with SCD to enter pregnancy in the best possible health state and with a clear understanding of the potential challenges ahead. It allows for the early establishment of a multidisciplinary care team, which should include specialists in maternal-fetal medicine, hematology, genetics, and social support services.

With proper planning and management, many women with SCD can have successful pregnancies, though the journey requires vigilant monitoring and proactive care. The WHO recommendations emphasize that effective outcomes are achievable through early intervention and a team-based approach to care.

With this foundation in understanding sickle cell disease in pregnancy, we’ll next explore the specific recommendations for preconception care for women with SCD, which builds upon the importance of planning and preparation discussed in this section.

Preconception Care for Women with SCD

Preconception Care for Women with SCD

Now that we understand the unique challenges that sickle cell disease (SCD) presents during pregnancy, it’s essential to address the crucial steps women with SCD should take before conception. With proper preconception care, women can significantly reduce risks and improve outcomes for both mother and baby. As noted in recent research, SCD has evolved over the past 50 years with improved survival rates, allowing many women with SCD to consider pregnancy—though careful planning remains vital.

Genetic Counseling and Partner Screening

Genetic counseling is a cornerstone of preconception care for women with SCD. Since sickle cell disease is inherited in an autosomal recessive pattern, understanding the genetic implications for potential offspring is crucial. Women with SCD should be offered comprehensive genetic counseling to understand:

• The inheritance pattern of SCD and the chances of passing the condition to children
• Options for partner screening to determine if the partner carries the sickle cell trait
• The range of potential outcomes based on both parents’ genetic status

Partner screening is particularly important as it helps couples understand the probability of having a child with SCD. If both parents have sickle cell trait or disease, there’s a higher risk of having a child with SCD. According to the reference material, pre-implantation genetic diagnosis is also an option that has been enhanced in updated guidelines, allowing couples to make informed reproductive choices before pregnancy occurs.

Optimizing Health Status Before Pregnancy

Given the significant maternal and fetal risks associated with SCD during pregnancy, optimizing health status before conception is critical. This includes:

• Comprehensive screening for hypertension and pulmonary hypertension, as these conditions affect a significant percentage of SCD patients and can lead to increased maternal mortality
• Managing baseline anemia, which is often exacerbated during pregnancy
• Ensuring appropriate immunizations are up-to-date to reduce infection risks, as women with SCD have heightened susceptibility to infections due to altered immune responses
• Assessment of cardiopulmonary and renal function, as these systems face significantly elevated demands during pregnancy
• Screening for and managing any existing vascular damage, which can affect placental vascularization and increase risks of preeclampsia and fetal growth restriction

A multidisciplinary approach involving hematologists, obstetricians, and other specialists is essential during this optimization phase to establish baseline health metrics and develop personalized care plans.

Medications and Treatments to Adjust Before Conception

Several medications and treatments commonly used for SCD management may need adjustment before attempting conception:

• Women should consult healthcare providers about safer birth control options while optimizing their health, with particular caution regarding estrogen-containing contraceptives, which increase the risk of stroke and blood clots in women with SCD
• Progesterone-only contraceptive methods are generally considered safer options while preparing for pregnancy
• Hydroxyurea, a medication commonly used to treat SCD, may need to be discontinued before conception due to potential teratogenic effects
• Pain management strategies should be reviewed and adjusted to ensure safety during pregnancy
• Blood transfusion requirements should be assessed, as 30-60% of SCD pregnancies require transfusions due to increased blood volume and red cell mass needs

Women taking medications for SCD complications should have a medication review with their healthcare team to identify any drugs that might be harmful during pregnancy and discuss safer alternatives.

With a solid preconception care plan in place, women with SCD can transition more smoothly into pregnancy with reduced risks. In the next section on Antenatal Care Recommendations, we’ll explore how this foundation of preconception planning translates into specialized care during pregnancy to monitor and address the unique challenges that may arise throughout gestation.

Antenatal Care Recommendations

Antenatal Care Recommendations

Now that we’ve discussed the importance of preconception care for women with sickle cell disease (SCD), let’s focus on the comprehensive antenatal care recommendations that are crucial for managing SCD during pregnancy.

According to the World Health Organization’s first global guideline released on June 19, 2025, enhanced pregnancy care for women with SCD requires specific attention to monitoring protocols and management strategies. These recommendations aim to reduce the significant maternal and perinatal risks associated with SCD during pregnancy.

A. Frequency and components of antenatal visits

Women with SCD require more frequent and specialized antenatal care compared to the general population. The British Society for Haematology and the Society for Maternal-Fetal Medicine recommend:

• Management by a multidisciplinary team from early pregnancy, including specialists in maternal-fetal medicine, hematology, genetics, and social support
• More frequent antenatal visits to monitor both maternal health and fetal development
• Early involvement of specialists to develop individualized care plans based on the patient’s SCD history and current status
• Comprehensive assessments during each visit to evaluate SCD-related complications and pregnancy progression

Each antenatal visit should include standard pregnancy evaluations plus specific assessments for SCD-related complications such as acute chest syndrome, severe anemia, and vaso-occlusive crises. The multidisciplinary approach is essential in both high-income and low-income settings to reduce morbidity and mortality during pregnancy.

B. Essential screening tests and monitoring protocols

The following screening tests and monitoring protocols are recommended for pregnant women with SCD:

• Regular fetal growth surveillance starting from 28 weeks of gestation, with more frequent monitoring for those with complications
• Individualized antenatal testing for patients with complicated SCD or a normally grown fetus from 32 to 34 weeks of gestation
• Blood tests to monitor hemoglobin levels, reticulocyte count, and other SCD-specific parameters
• Assessment for iron deficiency before supplementation, as unnecessary iron can exacerbate SCD complications
• Administration of all standard antenatal vaccinations, including meningococcal and pneumococcal vaccines when due
• Provision of prenatal vitamins without iron (unless iron deficiency is confirmed)
• Initiation of daily folic acid supplementation to support increased demands during pregnancy
• Regular screening for preeclampsia, which occurs at higher rates in women with SCD

The updated guidelines emphasize enhanced ultrasound frequency compared to previous recommendations, allowing for closer monitoring of fetal development and early detection of growth restrictions.

C. Management of acute sickle cell crises during pregnancy

Acute sickle cell crises during pregnancy require prompt and effective management to prevent maternal and fetal complications. The recommendations include:

• Evidence-based pain management strategies tailored to pregnancy status
• Careful consideration when using opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy
• Individualized use of prophylactic transfusions in high-risk patients, guided by specialists with experience in managing SCD in pregnancy
• Prompt evaluation and treatment of infections, which can trigger crises
• Adequate hydration and oxygenation to prevent sickling events
• Close monitoring for signs of acute chest syndrome, which can be life-threatening during pregnancy
• Immediate medical attention for any signs of vaso-occlusive crises, with treatment plans that balance maternal needs with fetal safety

During crises, the multidisciplinary team should work together to manage pain effectively while monitoring fetal well-being. The goal is to minimize the impact of the crisis on both mother and baby while preventing escalation to more severe complications.

With this comprehensive antenatal care approach, most pregnancies in women with SCD can result in healthy live births despite the inherent risks. In the next section, we’ll explore the pharmacological management during pregnancy, including the controversial use of hydroxyurea and appropriate pain management strategies for women with SCD.

Pharmacological Management During Pregnancy

Pharmacological Management During Pregnancy

Now that we have covered the essential antenatal care recommendations for women with sickle cell disease (SCD), it’s crucial to understand the appropriate pharmacological management during pregnancy. Women with SCD require careful medication management to balance the treatment of their condition while ensuring fetal safety. A multidisciplinary approach involving maternal-fetal medicine specialists, hematologists, and other healthcare providers is essential for developing individualized medication plans.

Safety and Efficacy of Hydroxyurea and Other Medications

Hydroxyurea, a medication commonly used to reduce the frequency of painful crises in SCD patients, requires careful consideration during pregnancy. The WHO recommendations emphasize shared decision-making regarding hydroxyurea use during pregnancy. While historically there have been concerns about potential teratogenic effects, more recent evidence suggests that individualized approaches may be appropriate for some high-risk patients.

For women who were using hydroxyurea before conception, healthcare providers should discuss:

• The potential risks and benefits of continuing therapy
• Alternative management strategies if discontinuation is advised
• Close monitoring protocols if continuation is deemed necessary

Other medications routinely used in SCD management must also be evaluated for pregnancy safety. This includes:

• Antibiotics for infection prophylaxis
• Antihypertensive medications for blood pressure control
• Anticoagulants for those at high risk of thrombotic events

Each medication should be reviewed by specialists familiar with both SCD and obstetric pharmacology to determine the safest and most effective regimen for each patient.

Appropriate Pain Management Strategies

Pain management represents one of the most critical aspects of SCD care during pregnancy. The WHO recommendations emphasize evidence-based pain management strategies that balance maternal comfort with fetal safety.

Key approaches include:

• Tiered analgesic protocols: Starting with safer options and escalating as needed
• Opioid management: When necessary for severe pain, opioids may be used with careful monitoring and planning to minimize neonatal effects
• NSAID considerations: These medications should be used with caution, particularly in the third trimester, due to potential effects on fetal circulation
• Non-pharmacological interventions: Including hydration therapy, physical therapy, and behavioral pain management techniques

A structured pain management plan should be developed early in pregnancy and modified as needed throughout gestation. This plan should involve input from pain specialists, hematologists, and obstetric providers to create a comprehensive approach that addresses both acute crises and chronic pain.

Prophylactic Treatments to Prevent Complications

Prophylactic interventions play a vital role in preventing SCD-related complications during pregnancy. The WHO recommendations highlight several key preventive measures:

Transfusion Therapy:

• Individualized prophylactic transfusion protocols for high-risk patients
• Decisions about transfusion therapy should be guided by SCD specialists
• Careful monitoring for transfusion reactions and alloimmunization

Infection Prevention:

• Administration of all standard antenatal vaccinations
• Meningococcal and pneumococcal vaccines when due
• Appropriate antibiotic prophylaxis when indicated

Nutritional Supplementation:

• Prenatal vitamins without iron, unless iron deficiency is confirmed
• Folic acid supplementation to support increased hematopoiesis
• Vitamin D and calcium as needed for bone health

Thromboprophylaxis:

• Assessment for venous thromboembolism (VTE) risk, which is fourfold higher in SCD patients
• Appropriate mechanical or pharmacological prophylaxis for those at highest risk
• Special attention to postpartum thromboprophylaxis plans

These prophylactic measures should be tailored to each patient’s specific risk profile, disease severity, and pregnancy status. Regular reassessment throughout pregnancy allows for adjustments as maternal and fetal conditions evolve.

With appropriate pharmacological management in place, the next important consideration is preparing for and effectively managing the specific complications that may arise during pregnancy in women with SCD. In the next section, we’ll explore detailed strategies for managing SCD complications in pregnancy, including acute chest syndrome, vaso-occlusive crises, and other potential emergencies that require prompt intervention.

Managing SCD Complications in Pregnancy

Managing SCD Complications in Pregnancy

Now that we’ve explored the pharmacological management options for pregnant women with sickle cell disease (SCD), it’s crucial to understand how to effectively manage the specific complications that may arise during pregnancy. Despite advancements in healthcare, pregnant women with SCD face significantly elevated risks of maternal and fetal morbidity and mortality compared to the general population. These complications require specialized approaches for prevention and management.

Prevention and Treatment of Acute Chest Syndrome

Acute chest syndrome (ACS) represents one of the most serious complications for pregnant women with SCD. This potentially life-threatening condition is characterized by chest pain, fever, and pulmonary infiltrates, and requires immediate attention when it occurs during pregnancy.

Prevention strategies include:

• Early referral to a multidisciplinary team including both sickle cell specialists and obstetric providers
• Regular monitoring of respiratory symptoms during antenatal visits
• Prompt administration of appropriate vaccinations, including pneumococcal and meningococcal vaccines
• Maintaining adequate hydration throughout pregnancy

When ACS is suspected during pregnancy, management should include:

• Immediate hospitalization for close monitoring
• Oxygen supplementation to maintain adequate saturation
• Appropriate antibiotic therapy to address potential infections
• Individualized transfusion protocols based on clinical severity
• Pain management with medications deemed safe during pregnancy
• Respiratory therapy and incentive spirometry to prevent atelectasis

Addressing Anemia and Blood Transfusion Protocols

Anemia is nearly universal in pregnant women with SCD and requires careful monitoring and management. The physiological changes of pregnancy can exacerbate anemia, potentially leading to worsened maternal and fetal outcomes.

Transfusion approaches include:

Prophylactic Transfusion:

• May be considered for high-risk patients with history of severe complications
• Should be individualized based on patient history, current clinical status, and specialist recommendations
• Regular monitoring of hemoglobin levels and reticulocyte counts

Selective Transfusion:

• Implemented for specific indications such as worsening anemia, signs of fetal growth restriction, or preparation for delivery
• May be necessary during acute complications such as ACS or severe vaso-occlusive crises

Important considerations for transfusion therapy include:

• Regular screening for alloantibody development
• Monitoring for transfusion reactions
• Prevention of iron overload with appropriate monitoring
• Assessment of fetal wellbeing following transfusions

It’s important to note that while transfusion therapy is a cornerstone of management, the evidence regarding its efficacy in improving pregnancy outcomes has not been rigorously studied, highlighting the need for more research in this area.

Managing Vaso-Occlusive Crises During Pregnancy

Vaso-occlusive crises (VOCs) frequently occur during pregnancy and can significantly impact maternal and fetal wellbeing. The metabolic demands of pregnancy, coupled with the hypercoagulable state and endothelial dysfunction, can increase the frequency and severity of these painful episodes.

Management strategies include:

Preventive Approaches:

• Adequate hydration
• Avoidance of triggering factors such as extreme temperatures and dehydration
• Low-dose aspirin therapy to prevent preeclampsia and potentially reduce vaso-occlusive events
• Venous thromboembolism (VTE) prophylaxis during hospitalization

Acute Management:

• Evidence-based pain management strategies using medications deemed safe during pregnancy
• Early intervention to prevent escalation of pain and potential complications
• Individualized pain management plans established before pregnancy when possible
• Close monitoring of fetal wellbeing during severe episodes
• Consideration of transfusion therapy for severe or recurrent crises

Effective management of VOCs requires a collaborative approach between the patient and healthcare providers, with clear communication about pain management strategies and emergency protocols.

With this comprehensive approach to managing SCD complications during pregnancy, we can now turn our attention to the critical considerations for labor and delivery, where specialized care continues to be essential for optimizing outcomes for both mother and baby.

Labor and Delivery Considerations

Labor and Delivery Considerations

Now that we have covered the management of SCD complications during pregnancy, it is crucial to understand the specific considerations for labor and delivery. Women with sickle cell disease face unique challenges during childbirth that require specialized care to ensure optimal outcomes for both mother and baby.

Optimal Timing and Mode of Delivery

For pregnant women with SCD, decisions regarding timing and mode of delivery should be made on an individualized basis, considering both maternal and fetal factors. According to recent evidence, there is no universal recommendation for elective cesarean delivery for all SCD patients. However, cesarean delivery may be warranted based on obstetric indications or in cases of severe maternal complications.

The timing of delivery requires careful consideration. While avoiding prolonged pregnancy is generally advised to reduce complications, there’s no definitive evidence supporting routine early delivery in all cases. The decision should balance the risks of prematurity against the potential for late pregnancy complications in women with SCD.

For high-risk patients, particularly those with a history of severe complications, planning for delivery at a facility with expertise in managing SCD and access to specialized care is essential. This includes availability of hematology consultation and blood bank services for potential transfusion needs.

Pain Management During Labor

Pain management is a critical aspect of care during labor for women with SCD, as labor can trigger painful vaso-occlusive crises. A comprehensive approach to pain control should be established early in the labor process.

Evidence suggests that early administration of epidural anesthesia may be beneficial for SCD patients, as it provides effective pain relief while potentially reducing the need for systemic opioids. This approach may help prevent the cascade of pain, anxiety, and dehydration that can precipitate a sickle cell crisis during labor.

Maintaining adequate hydration throughout labor is essential to prevent hemoconcentration and subsequent sickling. Intravenous fluids should be administered judiciously, with careful monitoring of fluid balance to avoid both dehydration and fluid overload.

Prevention of Complications During Delivery

Blood transfusion therapy plays a significant role in preventing complications during delivery for women with SCD. According to the American Society of Hematology guidelines, there are specific recommendations regarding transfusion during the peripartum period.

For pregnant SCD patients approaching delivery, clinicians may consider either prophylactic transfusion therapy or standard care without routine prophylactic transfusions. This decision should be based on the patient’s history of SCD-related complications and current clinical status. The TAPS2 trial, which investigated the feasibility of serial prophylactic exchange blood transfusion (SPEBT) in pregnant women with SCD, found trends suggesting fewer vaso-occlusive crises and improved birth weights in the intervention group, although the differences were not statistically significant.

For those receiving transfusions, both simple and exchange transfusions may be utilized, with the choice between manual and automated exchange transfusion influenced by their respective benefits and risks. Extended red cell antigen profiling is suggested for all SCD patients prior to transfusion, with strong support for prophylactic matching of Rh and K antigens to reduce alloimmunization risks.

Additional preventive measures during delivery include:

• Maintaining normal body temperature to prevent cold-induced vasoconstriction
• Ensuring adequate oxygenation
• Preventing acidosis
• Monitoring for signs of acute chest syndrome, which can develop rapidly during the peripartum period

Multidisciplinary care involving obstetricians, hematologists, anesthesiologists, and neonatal specialists is essential for optimal management of labor and delivery in women with SCD. This collaborative approach allows for prompt recognition and management of potential complications.

With appropriate attention to these labor and delivery considerations, we can significantly improve outcomes for women with SCD. In the next section, we will discuss postpartum care guidelines, which are equally important for ensuring the continued well-being of both mother and infant after delivery.

Postpartum Care Guidelines

Postpartum Care Guidelines

Now that we have covered the critical aspects of labor and delivery considerations for women with sickle cell disease (SCD), it’s essential to focus on postpartum care, which presents its own unique challenges for these mothers.

Managing SCD symptoms after childbirth

The postpartum period requires special attention for women with sickle cell disease, as they remain at heightened risk for pain crises and other complications. Recent netnographic research analyzing the experiences of postpartum women with SCD highlights significant concerns regarding respectful maternity care principles during this critical time.

The study identified that women with SCD often face challenges in receiving appropriate symptom management after childbirth. Pain management strategies should be continued and potentially adjusted during the postpartum period, with healthcare providers remaining vigilant for signs of vaso-occlusive crises that can be triggered by the physiological changes occurring after delivery.

Healthcare professionals should implement qualified listening techniques when assessing postpartum women with SCD, as advocated by recent research. This approach ensures that women’s reported symptoms are taken seriously and addressed promptly, which is crucial for preventing the escalation of SCD-related complications during recovery.

Breastfeeding considerations and medication safety

Women with SCD who choose to breastfeed require special guidance regarding medication safety. The research indicates that there is often a lack of informed consent and proper information provided to these mothers about how their SCD medications might affect breastfeeding.

Healthcare providers should:

• Provide clear information about which pain medications and SCD treatments are compatible with breastfeeding
• Discuss potential alternatives if certain medications pose risks
• Support mothers in making informed decisions about breastfeeding based on their individual health needs

The thematic analysis conducted via MAXQDA in the referenced study emphasizes the importance of respectful treatment, which includes providing comprehensive information about medication options during the postpartum period. This approach aligns with the identified key rights for women, particularly regarding informed consent and freedom from harm.

Prevention of postpartum complications

Prevention of complications during the postpartum period is paramount for women with SCD. The research underscores that the Sustainable Development Goals (SDGs) for women by 2030 are not positively reflected in the experiences of postpartum women with SCD, suggesting a significant gap in equitable care delivery.

Preventive measures should include:

• Regular monitoring for signs of infection, which women with SCD are more susceptible to
• Vigilant assessment for thromboembolism, which presents a higher risk in this population
• Continued hydration support to prevent sickling events
• Early mobilization with appropriate support to reduce the risk of complications

The study advocates for specialized health worker training to enhance respectful maternity care specifically for women with SCD. This training should address the unique demands of postpartum care for these women, including understanding the increased fatigue, potential for delayed healing, and heightened risk for acute chest syndrome in the postpartum period.

Implementing these preventive strategies requires a multidisciplinary approach, with clear communication between obstetric and hematology teams to ensure comprehensive care that addresses both the mother’s SCD management needs and routine postpartum care.

With these postpartum care guidelines in mind, we’ll next explore interpregnancy care and family planning strategies for women with SCD, which are crucial for maintaining long-term health and preparing for potential future pregnancies in a way that minimizes risks and optimizes outcomes.

Interpregnancy Care and Family Planning

Interpregnancy Care and Family Planning

Now that we have covered the essential postpartum care guidelines for women with sickle cell disease (SCD), it’s equally important to address the care needed between pregnancies. Proper interpregnancy care is crucial for women with SCD to maintain their health and prepare adequately for future pregnancies if desired.

A. Contraceptive options for women with SCD

Women with SCD require specialized family planning guidance that considers their unique health challenges. According to the WHO’s new guidelines, early discussions between healthcare providers and women with SCD regarding contraceptive options are essential. These conversations should ideally begin during preconception counseling and continue throughout the pregnancy journey.

Contraceptive choices for women with SCD should be:

• Individualized: Each woman’s specific health status, SCD complications, and personal preferences must be considered
• Evidence-based: Using methods that have been studied for safety in women with SCD
• Regularly reviewed: As health status may change over time, requiring adjustments to contraceptive approaches

The WHO recommendations emphasize the importance of skilled healthcare professionals being involved in these discussions to ensure women with SCD can make informed decisions about family planning that align with their health needs and reproductive goals.

B. Optimal spacing between pregnancies

For women with SCD, appropriate spacing between pregnancies is particularly important to allow the body to recover fully and optimize health before a subsequent pregnancy. The WHO guidelines address this critical aspect of interpregnancy care, noting that:

• Adequate spacing between pregnancies can reduce maternal and fetal risks
• Women with SCD may require longer recovery periods between pregnancies compared to women without chronic conditions
• Healthcare providers should discuss optimal pregnancy spacing as part of comprehensive care

This recommendation is especially relevant in low- and middle-income countries where SCD prevalence is high, and access to specialized care may be limited. Proper pregnancy spacing can be a cost-effective strategy to improve outcomes for both mothers and infants.

C. Ongoing health maintenance between pregnancies

The period between pregnancies offers a crucial opportunity for women with SCD to focus on their overall health maintenance. The WHO guidelines outline several key components of interpregnancy care:

• Continued folic acid supplementation: The guidelines highlight the importance of folic acid for women with SCD, which should be maintained between pregnancies
• Iron management: Appropriate iron supplementation based on individual needs should be continued
• Infection prevention: Ongoing measures to prevent infections that can trigger SCD crises
• Regular health monitoring: Continued surveillance for SCD complications and management of any chronic issues

Additionally, the interpregnancy period is an ideal time to address any health concerns that arose during the previous pregnancy and to optimize management of the underlying SCD. This approach aligns with the WHO’s emphasis on individualized care that respects the unique needs of women with SCD.

The guidelines also underscore the need for increased research and funding for SCD treatment, particularly for women of reproductive age. Historically, pregnant and breastfeeding women with SCD have been overlooked in clinical studies, creating gaps in evidence-based care. The WHO initiative acknowledges this deficiency and calls for more inclusive research to better inform interpregnancy care practices.

By following these recommendations for interpregnancy care and family planning, healthcare providers can help women with SCD maintain their health between pregnancies and make informed decisions about future reproductive choices, ultimately improving outcomes for both mothers and infants.

Conclusion

The management of sickle cell disease during pregnancy requires a comprehensive, multidisciplinary approach to ensure the best outcomes for both mother and baby. From preconception counseling through postpartum care, healthcare providers must remain vigilant about monitoring for complications while providing appropriate interventions. The WHO recommendations outlined in this blog post offer evidence-based guidance for clinicians worldwide, emphasizing the importance of specialized care, regular screening, and preventative measures throughout the pregnancy journey.

Women with sickle cell disease can experience safe pregnancies and healthy deliveries with proper medical support. By implementing these recommendations—including appropriate pharmacological management, specialized antenatal care, careful labor planning, and thoughtful interpregnancy care—healthcare systems can significantly reduce maternal and fetal morbidity and mortality. For those living with SCD, access to comprehensive reproductive healthcare is not just a medical necessity but a fundamental right that empowers informed family planning decisions and supports overall wellbeing.

 Stay informed, stay proactive, and give your child the gift of a healthier tomorrow through timely vaccinations.