WHO issues first global guideline for pregnant women with sickle cell disease

Pregnant woman profile of belly
image: ©beckyblanton iStock

The World Health Organization (WHO) has released its first-ever global guideline on the management of sickle cell disease (SCD) during pregnancy

Sickle cell disease is a group of inherited blood disorders characterised by abnormally shaped red blood cells that look like crescents or sickles. These cells block blood flow, causing severe anaemia, episodes of severe pain, recurrent infections, and medical emergencies such as strokes and sepsis.

These health risks are heightened during pregnancy due to additional demands on the body’s oxygen and nutrient supply. Women with sickle cell disease face a 4- to 11-fold higher likelihood of maternal death than those without. Along with being more likely to face obstetric complications like pre-eclampsia, their babies are also at greater risk of stillbirth or prematurely.

“With quality health care, women with inherited blood disorders like sickle cell disease can have safe and healthy pregnancies and births,” said Dr Pascale Allotey, Director for Sexual and Reproductive Health and Research at WHO and the United Nations Special Programme for Human Reproduction (HRP). “This new guideline aims to improve pregnancy outcomes for those affected. With sickle cell on the rise, more investment is urgently needed to expand access to evidence-based treatments during pregnancy as well as diagnosis and information about this neglected disease.”

The prevalence of sickle cell disease has surged by over 40% since 2000

Approximately 7.7 million people worldwide are affected by sickle cell disease, a condition that has been steadily increasing in prevalence. The condition is estimated to cause over 375,000 deaths per year and is most prevalent in malaria-endemic regions.  However, the sickle cell gene is becoming more widespread globally. Therefore, global guidelines for the condition will support maternity care providers in managing the disease.

Previous clinical guidelines for managing sickle cell disease in pregnancy draw upon protocols from high-income countries. The WHO’s new guidance aims to provide evidence-based recommendations relevant to low- and middle-income countries, where most cases and deaths occur.  The guideline includes recommendations on:

  • folic acid and iron supplementation, including adjustments for malaria-endemic areas;
  • management of sickle cell crises and pain relief;
  • prevention of infections and blood clots;
  • use of prophylactic blood transfusions and
  • additional monitoring of the woman and the baby’s health throughout pregnancy.

Helping women make informed decisions during their pregnancy

Sickle cell disease remains underfunded and under researched. The guideline outlines the need for respectful, individualised care whilst highlighting the importance of tackling stigma and discrimination within healthcare settings.

“It’s essential that women with sickle cell disease can discuss their care options early in pregnancy—or ideally before—with knowledgeable providers,” said Dr Doris Chou, Medical Officer and lead author of the guideline. “This supports informed decisions about any treatment options to continue or adopt, as well as agree on ways of handling potential complications, to optimise outcomes for the woman, her pregnancy, and her baby.”

While treatment options are improving, the guideline underscores the pressing need for more research into the safety and efficacy of sickle cell disease treatments for pregnant and breastfeeding women, two populations that are often excluded from clinical trials.

This publication is the first in a new World Health Organisation (WHO) series on managing non-communicable diseases in pregnancy. Future guidelines will address cardiovascular conditions, diabetes, respiratory diseases, mental health disorders and substance use. Chronic diseases are increasingly recognised as major contributors to maternal and newborn deaths and ill health.

OAG Webinar

LEAVE A REPLY

Please enter your comment!
Please enter your name here