Sickle cell disease often becomes more severe – and pain episodes more frequent – during pregnancy, particularly in the third trimester. A pregnant woman with sickle cell disease is more likely to have a miscarriage, still birth, preterm labor, or a low-birth-weight baby and Sickle cell pregnancies are almost always considered high risk.
Ideally, women with sickle cell disease should receive preconception counseling. This is because with early prenatal care and careful monitoring, women with sickle cell disease can have a healthy pregnancy and successful delivery.Women with sickle cell are more prone to pain episodes during pregnancy, especially during the third trimester.
Pregnancy creates intense demands on a woman’s body, and the normal physiologic changes of pregnancy – and common complications like anemia – can easily make the sickling of red blood cells worse. If blood vessels become blocked by sickled cells, body tissues may be deprived of oxygen and die. Even minor areas of damage in the placenta may reduce the amount of oxygen and nutrients available for the baby’s growth in the womb.
Additional complications for the mother may include:
- Infections, including urinary tract infection, pneumonia, and uterine infection, which can all lead to pain episodes
- Gallbladder problems, including gallstones
- Heart enlargement and heart failure from anemia
You and your doctor should work together to make sure you have a healthy baby. First, you’ll need an obstetrician who specializes in high-risk pregnancies (called a perinatologist) and a blood specialist (hematologist). It makes sense to meet with your pregnancy caregiver for a preconception appointment. If you take hydroxyurea to prevent pain episodes, your doctor will probably recommend that you avoid it when you’re pregnant, and maybe even when you’re trying to conceive. Studies indicate that it can increase the risk of birth defects.
Once you’re pregnant, you’ll have frequent prenatal doctor visits, which will include regular blood and urine tests. At your first prenatal visit, your initial tests may include a complete blood count, hemoglobin electrophoresis (for your partner as well), liver function tests, a test for hepatitis B and C, blood group and antibody typing, a test for rubella antibodies, and a syphilis test.
Pregnant women who have sickle cell anemia are almost always found to be anemic at the first prenatal visit. The anemia is typically caused by hemolysis (destruction of red blood cells) rather than iron deficiency, so iron supplements won’t help. Blood transfusions are the typical treatment. Some sickle cell patients may be overloaded with iron because of frequent past blood transfusions. They may be advised to avoid iron supplements but would still benefit from prenatal vitamins.
Morning sickness poses extra risks for women who have sickle cell, as it can lead to dehydration, which can cause a pain episode. During the last trimester you may have additional fetal testing. Anemia is likely to be most severe during the final months of pregnancy and may require blood transfusions.
The general care guidelines for a person with sickle cell disease are even more important during pregnancy. These tips will help you keep pain episodes at bay.
Take folic acid. Follow your doctor’s recommendations for a healthy diet, including taking a folic acid supplement every day. In addition to helping prevent neural tube defects, folic acid will help your bone marrow make new red blood cells.
Drink plenty of water. Try to get at least eight glasses of water a day – especially in warm weather – to keep your body well hydrated.
Get plenty of sleep. Talk to your doctor if you are having trouble sleeping or staying asleep.
Avoid extremes of heat and cold. Extreme temperatures can cause cells to sickle. Bundle up whether you’re outside in cold weather or in a chilly air-conditioned room. Avoid swimming in cold water.
Avoid other extreme conditions. While you’re not going to take up mountain climbing or scuba diving while pregnant, you might want to be cautious about other situations that involve high altitudes and low oxygen, like flying or traveling to cities at high elevation.
Reduce stress. If you’re feeling overwhelmed or depressed, talk to your doctor. Studies indicate that stress can trigger sickle cell pain episodes. It may be helpful to find a support group, such as the Sickle Cell Foundation clubs, to help you cope with daily life.
Prevent infections. Talk to your doctor about getting the flu shot and make sure you’re up-to-date with other vaccines. Contact your doctor if you have any signs of an infection, such as fever or trouble breathing.