Sickle Cell Disease and Infertility (Part 4)

Dr Kemi Ailoje

Last week we talked about Sickle Cell Disease (SCD) and attempting pregnancy. In concluding this topic, we will be addressing preventions of complications in a pregnant patient with SCD.

Complications of sickle cell disease can be avoided by preventing red blood cells from becoming sickle cell shaped and staying around. Ways to help sickle cell stay round are:

Drinking plenty water.

Avoiding extremely hot or cold temperatures.

Avoiding places or situations with low oxygen, such as high altitudes, military boot camp or strenuous athletic training.

Getting plenty of rest and taking frequent breaks during exercise.

How does sickle cell affect pregnancy?

With sickle cell disease, you will have a higher risk of certain pregnancy complications. Including miscarriage, preterm delivery and having baby with a low birth weight.

High blood pressure and pre-eclampsia is a potentially dangerous pregnancy complication characterized by the sudden onset of high blood pressure. This is more common in women with sickle cell disease. As far as child birth is concerned, you are slightly more likely to have a C-section that is mostly due to the increased rate of pregnancy complication characterized by the sudden onset of high blood pressure.

The above however does not apply to all patients with SCD as some of them go through pregnancy with minimal complications while some may need special treatment and specialist care.

In Need of 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 fall in this category, your doctor may recommend a prenatal vitamin that has no iron.

Some SCD patient may need to receive more blood transfusions at some point during pregnancy.

A prenatal check-up more frequent than other women in order to ensure closer monitoring during routine prenatal check is recommended.

Low dose Aspirin will increase blood flow to the womb and reduce the risk of pre-eclampsia. Women with SCD should be closely monitored for elevated blood pressure.

Regular routine urinalysis is also crucial.

They should also be offered a viability scan at 7-9 weeks of gestation, routine first-trimester scan (11-14 weeks of gestation) and a detailed anomaly scan at 20 weeks. In addition, they should be mandated to have serial fetal biometry scans (growth scans) every 4 weeks from 24 weeks of gestation. A number of studies suggest that women with SCD are at risk of fetal growth restriction as well as pre-eclampsia. Serial growth scans allow early detection of fetal growth restriction and thus aid appropriate timing of delivery to reduce perinatal mortality and morbidity.

Treating Sickle Cell Crises /Pain.

Sickle cell crisis can be effectively managed through the following steps:

Take a pain reliever only as recommended by your physician as certain medications are not safe till about 12-28 weeks of pregnancy, hence avoiding across the counter pain reliever usage is of immense importance to the survival of the pregnancy.

Ensure to take plenty fluid to enhance proper hydration.

Use a warm towel or a heated pad to gently massage the affected body part.

Treatments for Anaemia

Anaemia (reduction in the healthy red cells in blood) often causes few symptoms and may not require specific treatment. However, dietary supplements such as folic acid (which help stimulates the production of red blood cells) are helpful.

Anaemia caused by sickle cell disease is not the same as the more common iron deficiency anemia. Blood transfusion and administration of oxygen may be required in some cases.

Child Birth Options:

While safe vagina delivery is not contraindicated in sickle cell disease, best option for delivery remains induction of labour or elective Caesarean section.

Adequate Hydration throughout pregnancy, during delivery and post-partum is very important. Also, prior to delivery provisions should have been made for blood transfusion.

Women with sickle cell disease who intend getting pregnant should visit their physician who provides counselling and assessment. This enables him/her to identify medications the individual may be using that is needed before conception or those not suitable for and in pregnancy.

In conclusion, it is important to note that despite the fact that women have this chronic life threatening condition of sickle cell disease in pregnancy, they can still enjoy safe motherhood if they are closely monitored by their physician before, during, after pregnancy and child birth.