Every year, sickle cell disease is estimated to cause over 375, 000 deaths, according to the

World Health Organization (WHO). Among them are hundreds of thousands of women with sickle cell disease face life-threatening risks during pregnancy—often without access to proper care.

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On June 19, WHO released its first-ever global guideline on the management of sickle cell disease (SCD) during pregnancy, addressing a critical and growing health challenge that can have life-threatening consequences for both women and babies.

Sickle cell disease is a group of inherited blood disorders characterized by abnormally shaped red blood cells that resemble crescents or sickles. These cells can block blood flow, causing severe anaemia, episodes of severe pain, recurrent infections, as well as medical emergencies like strokes, sepsis or organ failures.

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Dr Gerard Mbabazi, an obstetrics and gynecology resident at Rwanda Military Referral and Teaching Hospital, told The New Times that sickle cell disease poses serious risks especially during pregnancy because the expectant mothers’ body requires high oxygen and nutrients supply for both the mother and her baby to thrive.

He said: "The risks include anemia, infections, pre-eclampsia or eclampsia, higher risk of blood clots, premature birth, and miscarriage or still birth. However, with proper close monitoring and care, women with sickle cell disease can deliver healthy babies and avoid life-threatening complications.”

According to WHO, women with sickle cell disease face a 4- to 11-fold higher likelihood of maternal death than those without. They are more likely to experience obstetric complications like pre-eclampsia, while their babies are at greater risk of stillbirth or being born early or small.

Pre-eclampsia is a pregnancy complication characterized by high blood pressure (hypertension) and signs of damage to another organ system, most often the kidneys, after 20 weeks of pregnancy. It can also occur following childbirth, typically within 48 hours of delivery. The complication can range in severity and may affect both the mother and the developing baby.

"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, the 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.”

7.7 million people living with sickle cell disease

There are around 7.7 million people living with sickle cell disease worldwide – a figure that has increased by over 40% since 2000, according to WHO.

As noted, the disease is most prevalent in malaria-endemic regions, particularly sub-Saharan Africa--which accounts for around 8 in 10 cases--as well as parts of the Middle East, the Caribbean, and South Asia. With population movements and improvements in life expectancy, the sickle cell gene is also becoming more widespread globally, meaning more maternity care providers need to know how to manage the disease.

Dr Mbabazi said that "it is recommended” that women with sickle cell disease begin preconception counselling and antenatal care as early as possible "and attend all scheduled visits consistently.”

He added: "Key management strategies include preventing crises through adequate fluid and nutrient intake, taking folic acid tabs, avoidance of triggers such as infections, cold weather, and stress, and undergoing regular blood tests, fetal monitoring and use of safe analgesics during crises.”

Folic acid tablets, Dr Mbabazi explained, are prescribed as supplements "but again, there are lots of foods that contain folic acid (Vitamin B9); like dodo [amaranth], isombe [cassava leaves], beans, fruits such as avocado, papaya, oranges, bananas, and many more.”

Blood transfusions may also be required to manage severe anemia or prevent complications, he said.

Dr. Rachna Pande, a specialist in internal medicine, said: "Symptoms can be prevented or minimized by healthy life style. Genetic counselling during pregnancy is also helpful. Regular prenatal check up and following advice is important for someone who has sickle cell disease and becomes pregnant, because there is greater risk for having severe joints pain, weakness. Healthy life style, and good hygiene, is important in preventing infections.”

Until now, according to WHO, clinical guidance for managing sickle cell disease in pregnancy has largely drawn on protocols from high-income countries. The UN health agency’s new guideline aims to provide evidence-based recommendations that are also relevant for low- and middle-income settings, where most cases and deaths from the disease occur.

Accordingly, the guideline includes over 20 recommendations spanning: