Sickle Cell & Pregnancy: High-Risk Journey

Pregnancy presents heightened health challenges for expectant mothers with sickle cell anaemia, a condition characterized by sickle-shaped red blood cells that can block blood vessels.

Globally, approximately three hundred thousand children are born with sickle cell disease annually. India shoulders the world's second-highest disease burden, with prevalence rates reaching around 1% in regions like Chhattisgarh, Madhya Pradesh, Gujarat, and Maharashtra.

During pregnancy, physiological changes like increased blood volume and cardiac workload can exacerbate sickle cell complications. This leads to a sixfold higher maternal mortality rate compared to the general population. Patients face increased risks of infections, preeclampsia, hypertension, blood clots, and preterm labor, occurring 2.4 times more frequently.

Infants born to mothers with sickle cell anaemia are at higher risk of intrauterine growth restriction, premature birth, and in-utero death. Neonatal Opioid Withdrawal Syndrome is also a concern if mothers require opioid pain relief.

Managing these pregnancies requires integrated care from maternal-fetal medicine specialists and hematologists. Delivery should occur in well-equipped hospitals with ICU support. Genetic counseling for parents and prenatal testing options like CVS or amniocentesis are vital. Maintaining maternal hemoglobin above 9-10 gm% and regular fetal growth monitoring are critical.

Treatment strategies include hospitalization for sickle crises with analgesics, oxygen, and hydration, potentially requiring blood transfusions or exchange transfusions. Aspirin and low molecular weight heparin are used to prevent blood clots, while Hydroxyurea may be administered after the fourth month of pregnancy. Early antibiotic initiation is crucial to prevent severe infections.