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 be pregnant.

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.

REFERENCES
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