Sickle cell makes pregnancy challenging but not impossible

Women with sickle cell disease who get pregnant will almost always be considered high risk. Babycare.com notes that 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 also more likely to have a miscarriage, preterm labor, stillbirth or a low-birth-weight baby.

Ideally, women with sickle cell disease should receive preconception counseling. With early prenatal care and careful monitoring, women with sickle cell disease can have a healthy pregnancy and successful delivery. It’s best to have an obstetrician who specializes in high-risk pregnancies (called a perinatologist) and a blood specialist (hematologist). It makes sense to meet with your pregnancy caregivers for a preconception appointment.

If you have the disease, your child will inherit a sickle hemoglobin gene from you.

Because sickle cell is an inherited disease, and you have sickle cell trait, you could pass either a sickle hemoglobin gene or a normal hemoglobin gene to your child. When two people with sickle cell trait have a child, their child may inherit two normal genes, one normal and one sickle hemoglobin gene, or two sickle cell genes.

During pregnancy, there is intense pressure on a woman’s body physiologically. 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.

During your pregnancy, if you take hydroxyurea to prevent pain episodes, your doctor will probably recommend that you avoid it and maybe even when you’re trying to conceive. Studies indicate that the drug can increase the risk of birth defects. There is also a chance that a male taking the drug while trying to conceive may increase the opportunity for potential defects.

Other considerations to note: morning sickness poses extra risks for women who have sickle cell, because it can lead to dehydration, which can cause a pain episode.

The general care guidelines for a woman 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 higher elevations.

• 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 BabyCenter Community’s Sickle Cell moms and dads group, 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.

During delivery

Women with sickle cell disease can deliver vaginally, unless complications arise. In fact, vaginal delivery is preferred since C-sections present a higher risk of blood loss, infection, and pulmonary embolism (a blood clot that goes to your lungs).

During labor, your team of specialists will take great care to prevent a pain episode. You’ll probably receive intravenous (IV) fluids to help prevent dehydration as well as extra oxygen through a mask. A fetal heart rate monitor is often used to watch for changes in heart rate and signs of fetal distress.

After delivery, drink plenty of fluids to help prevent dehydration. Take special care of any stitches or incisions to prevent infection.

Prenatal testing

Prenatal testing can detect whether your baby has sickle cell disease, sickle cell trait, or neither. As early as the first trimester, doctors can take a sample of placental tissue (chorionic villus sampling, or CVS) to detect whether your baby has the genes that would lead to the disease or trait. After 17 weeks, amniocentesis can determine this information from the amniotic fluid.