Pregnancy carries some increased risk for a woman with sickle cell disease and her fetus, but risks are not so great as to prohibit desired pregnancies. Everyone sexually active woman affected with sickle cell disease should be advised of the likelihood that her pregnancies will be successful but should also be advised that some risks may be greater than for women without sickle cell disease. Particular attention should be given to ensure the genetics of sickle cell disease is understood.
Sickle cell disease is not an indication for sterilization. Contraception, however, offers the option of informed family planning. This should be discussed with the gynecologist. Adolescent and preteens should receive sex education that includes a discussion of abstinence. Low estrogen contraceptives are preferred.
Management of Pregnancy
Early medical care is imperative. Prenatal care should be in one set of hands, with advice from the others. It is advisable that care of pregnancy should be handled by a high-risk clinic of obstetricians who are experts in the care of the pregnant woman with sickle cell disease. All routine prenatal screening examinations should be performed with added assessment of the vital organs and life style. There should be screening for the presence of red cell alloantibodies, regardless of the history of transfusions. The father should also have his hemoglobin type identified. Genetics should be completely explained to both parents-to-be. Some physicians may institute prophylactic transfusions in asymptomatic pregnant patients with SS disease. Transfusions, however, play an important role in the management of acute events.