Women with sickle cell disease or sickle cell trait (those who are carriers of the gene that causes sickle cell disease) can often have safe and healthy pregnancies, but there are certain risks that are important to know about. If doctors fail to consider these risks or mismanage associated complications, this can harm the mother and/or cause the baby to sustain birth injuries.
What is sickle cell disease?
Sickle cell disease is a recessive inherited disorder; those who have it possess two copies of a genetic mutation that causes red blood cells to be abnormally shaped. These cells cannot transport oxygen as effectively as healthy cells, and also cluster together and hinder the movement of normal oxygen-carrying blood. People with sickle cell disease often experience painful symptoms and chronic anemia (also called sickle cell anemia) (1).
What is sickle cell trait?
People who have one copy of the sickle cell gene are called carriers or said to have sickle cell trait (as opposed to disease). They are typically asymptomatic or only experience symptoms during intense physical activity, when exposed to extreme temperatures, or when dehydrated (2). (Interestingly, those with sickle cell trait have the advantage of being less susceptible to malaria; for this reason the gene is common in malaria-endemic regions ).
Sickle cell disease: impacts on pregnancy
Expectant mothers with sickle cell anemia are more likely to experience the following complications (1, 4, 5):
- Kidney disease/infections
- Congestive heart failure/heart enlargement
- Urinary tract infections (UTIs)
- Lung infections
- Gallstones and other gallbladder problems
- Sickle cell crises (painful events)
- Vision problems
Some of these complications, such as kidney disease and congestive heart failure, may be preexisting but worsen during pregnancy.
Risks to the developing baby include the following (1, 4):
- Intrauterine growth restriction (IUGR)
- Premature birth
- Miscarriage, stillbirth, or newborn death
- Low birth weight
- Having sickle cell disease (inheritance of sickle cell disease will be discussed in more detail in the next section)
Sickle cell trait: will the baby have sickle cell disease?
In many cases, women with sickle cell trait will have normal pregnancies and give birth to healthy babies. However, if the baby’s father also has sickle cell trait, there is a chance that the baby will have sickle cell disease. If one parent already knows they have sickle cell trait, it is recommended that the other also be tested before trying to have a baby, or during the first prenatal visit (4). People are more likely to have sickle cell trait if they:
- Have a family history of sickle cell trait/disease
- Have ancestors from one of these regions:
- The Caribbean
- Saudi Arabia
- South America
- Central America
Clinicians can test for sickle cell trait by swabbing the inside of the mouth or drawing blood.
If both parents have sickle cell trait (but not disease), there is a 25% chance the baby will have sickle cell disease, a 50% chance they will have sickle cell trait, and a 25% chance they will not have either. Genetic counselors can help parents to further understand the likelihood of passing on sickle cell trait or disease.
Doctors can test the baby for sickle cell disease via amniocentesis (in which fluid amniotic fluid is drawn) or chorionic villus sampling (this involves testing placental tissue) (5).
Management of sickle cell disease/trait during pregnancy
For women with sickle cell disease, it is important to have early and frequent prenatal check-ups (4). Doctors will likely recommend changes in medication because some drugs that treat sickle cell disease (such as hydroxyurea) are not safe for growing babies. It is also a good idea to talk about medication changes before attempting to become pregnant (5).
In addition to providing general pregnancy advice (such as maintaining a healthy diet, staying hydrated, and taking prenatal vitamins) and conducting tests of fetal wellbeing (such as ultrasounds, nonstress tests, and biophysical profiles), doctors may need to intervene and address complications stemming from sickle cell disease (1).
In some cases, expectant mothers with sickle cell disease will need blood transfusions in order to replace sickled blood cells. This may need to be done multiple times over the course of pregnancy because it is very important that both mother and baby have enough red blood cells to carry the oxygen molecules. When giving a pregnant patient blood transfusions, it is important to ensure that antibodies in the donor blood will not negatively affect the fetus due to Rh incompatibility (a pregnancy complication in which the mother’s immune system reacts to fetal blood as a foreign substance and attacks it).
During labor, patients should also receive IV fluids. This can help to prevent dehydration, which is especially dangerous for those with sickle cell disease. The mother may also require an oxygen mask.
In most cases, women with sickle cell disease can deliver vaginally. However, the medical team should conduct fetal monitoring, and be prepared for an emergency C-section if dangerous complications arise or there are signs of fetal distress (1, 4). Failure to properly manage sickle cell disease in a pregnant patient is negligence, and if it causes harm to the mother and/or baby, it is considered medical malpractice.
About ABC Law Centers
ABC Law Centers was established to focus exclusively on birth injury cases. A “birth injury” is any type of harm to a baby that occurs just before, during, or after birth. This includes issues such as oxygen deprivation, infection, and trauma. While some children with birth injuries make a complete recovery, others develop disabilities such as cerebral palsy and epilepsy.
If a birth injury/subsequent disability could have been prevented with proper care, then it constitutes medical malpractice. Settlements from birth injury cases can cover the costs of lifelong treatment, care, and other crucial resources.
If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win.
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- Sickle Cell Disease and Pregnancy. (n.d.). Retrieved July 29, 2019, from https://www.stanfordchildrens.org/en/topic/default?id=sickle-cell-disease-and-pregnancy-90-P02499
- What is Sickle Cell Trait? | CDC. (n.d.). Retrieved July 29, 2019, from https://www.cdc.gov/ncbddd/sicklecell/traits.html
- CDC – Malaria – About Malaria – Biology. (n.d.). Retrieved July 29, 2019, from https://www.cdc.gov/malaria/about/biology/index.html
- Sickle Cell Disease and Pregnancy. (n.d.). Retrieved July 29, 2019, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02499
- Sickle cell disease and pregnancy. (n.d.). Retrieved July 29, 2019, from https://www.marchofdimes.org/complications/sickle-cell-disease-and-pregnancy.aspx