Sickle-cell disease (SCD) is a group of inherited blood disorders characterized by the presence of sickle-shaped red blood cells, caused by a mutation in the β-subunit of haemoglobin. It is an autosomal recessive condition that affects approximately 7.74 million people worldwide. The disease is particularly prevalent in sub-Saharan Africa, where it contributes significantly to maternal and child health burdens. Other high-prevalence areas include regions historically endemic to malaria, such as parts of the Middle East, the Caribbean, and South Asia. Due to migration, SCD also affects populations in North America, Europe, and other parts of the world.
Women living with SCD face a higher risk of complications during pregnancy and childbirth. These complications may include pre-eclampsia, intrauterine growth restriction, infections, thromboembolic events, and increased maternal and perinatal mortality. As such, the provision of specialized care and close monitoring during pregnancy is essential to ensure better outcomes for both the mother and the baby.
The development of guidelines specifically tailored to manage pregnancy in women with SCD is critical for improving clinical outcomes. These guidelines are intended to support frontline health-care providers, including obstetricians, midwives, nurses, and general practitioners, who are directly involved in providing care during pregnancy and childbirth. They provide evidence-based recommendations for antenatal surveillance, the use of medications like folic acid, prophylactic antibiotics, and transfusions, as well as strategies for pain management, hydration, and safe delivery planning.
Beyond frontline providers, these guidelines are a valuable resource for health-care managers and policy-makers responsible for maternal and child health programmes. They support the development of national and local protocols that integrate SCD management into routine maternity care, particularly in resource-limited settings. This alignment ensures that women with SCD receive equitable, timely, and effective care.
The guidelines are also essential for strengthening the health system through the development of educational and clinical tools. These tools can be incorporated into both pre-service and in-service training programmes, ensuring that health workers are well-equipped with the knowledge and skills needed to manage high-risk pregnancies associated with SCD. Furthermore, these guidelines contribute to broader health system goals, including reducing maternal and neonatal morbidity and mortality and promoting respectful, person-centered maternity care.
In conclusion, tailored guidelines for the management of SCD in pregnancy are a vital step toward addressing a global health challenge. They provide a framework for clinical practice, policy development, and workforce training, ultimately enhancing the quality of care for women with SCD and improving pregnancy outcomes in diverse health settings.
