• Regular ultrasound scans every 3 to 4 weeks starting from the 24th week of pregnancy are advised to monitor the baby’s growth and identify any potential issues early.

The World Health Organization (WHO) has recently released its first global guideline aimed at enhancing pregnancy care for women with sickle cell disease.

The guidelines seek to improve health outcomes for both mothers and their babies by providing tailored recommendations throughout the pregnancy journey.

1. Medicines and Supplements

Folic acid is critical for red blood cell production. Women in malaria-free regions should take 5 mg daily, while those in malaria-prone areas can take 400 micrograms if they are using malaria prevention medications.

Iron supplements are only recommended if there is clear evidence of iron deficiency, as excess iron can be harmful to individuals with sickle cell disease. Blood transfusions may benefit women who have experienced severe symptoms in the past.

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Hydroxyurea, once considered unsafe during pregnancy, may now be continued after the first trimester under specific circumstances, following careful discussions between the patient and healthcare provider.

Regular check-ups are essential for monitoring infections, and while routine antibiotics are not advised, prompt treatment for any signs of illness is crucial.

2. Pain Management

Pain is a common and often debilitating symptom in sickle cell disease, particularly during pregnancy. The WHO recommends personalized pain management plans that may include medications such as paracetamol, certain NSAIDs, and mild opioids, tailored to the stage of pregnancy.

3. In-Hospital Care

For women requiring hospitalization, careful management of fluids and clotting risks is essential. Monitoring heart, lung, and oxygen levels helps prevent complications, such as fluid overload.

4. Monitoring the Baby

Regular ultrasound scans every 3 to 4 weeks starting from the 24th week of pregnancy are advised to monitor the baby’s growth and identify any potential issues early.

5. Birth Planning

The mode of delivery—whether vaginal or cesarean—should be determined based on the health of the mother and the baby. Vaginal birth is preferred if there are no medical contraindications. The timing of delivery should weigh the risks and benefits for both mother and child.

6. Postnatal Care and Family Planning

Post-birth, women should receive close monitoring for six weeks to manage any symptoms of sickle cell disease. Healthcare providers should support safe breastfeeding practices, especially for those on medication, and assist in planning for future pregnancies.

Sickle cell disease affects millions worldwide, inherited through families and impacting how red blood cells function. Instead of being round and smooth, these cells become stiff and crescent-shaped, leading to difficulties in blood flow, pain, anemia, and other serious health issues.

Over 7.7 million individuals are affected globally, with the highest prevalence in sub-Saharan Africa.

Thanks to advancements in treatment, many people with sickle cell disease are living longer, healthier lives, leading to an increasing number of women with the condition reaching childbearing age.

However, pregnancy poses additional risks for both mothers and babies. Until now, WHO lacked specific global guidelines for managing pregnancy in women with sickle cell disease, relying on guidance primarily from high-income countries, which often lacked robust scientific backing and did not adequately address the needs of women in low- and middle-income countries.

Women with sickle cell disease face not only medical challenges but also stigma and misunderstanding about their condition. Some healthcare professionals may lack comprehensive knowledge about sickle cell disease and its genetic implications.

Therefore, training and education are vital components of these guidelines. Collaborative care involving doctors, nurses, psychologists, and other specialists is essential for providing holistic support.

Released on June 19th, coinciding with World Sickle Cell Day, these guidelines represent a significant step toward improving care for pregnant women with sickle cell disease.

They are based on expert opinions, available research, and practical experiences, particularly in resource-limited settings.