By Chantelle Muzanenhamo
Geneva, Switzerland — The World Health Organization (WHO) has unveiled its first-ever set of global guidelines aimed at improving the management of sickle cell disease (SCD) in pregnant women, with a focus on reducing the alarmingly high maternal and infant mortality rates associated with the condition in low- and middle-income countries.
Currently, clinical management protocols for pregnant women with SCD have largely been adapted from high-income countries, where healthcare resources and infrastructure are more developed. WHO highlighted that these guidelines are often not suitable for settings where most cases and deaths occur, underscoring the urgent need for context-specific recommendations.
SCD is a hereditary blood disorder characterized by abnormally shaped red blood cells that resemble crescents or sickles. These misshapen cells can obstruct blood flow, leading to severe anemia, intense pain episodes, recurrent infections, and life-threatening complications such as strokes, sepsis, and organ failure. During pregnancy, the risks escalate due to increased demands for oxygen and nutrients, making proper management critical.
Women with SCD face a significantly heightened risk during pregnancy, with studies indicating they are four to eleven times more likely to die compared to women without the disease. The disorder also raises the likelihood of obstetric complications like pre-eclampsia, while their babies are at increased risk of stillbirth, premature birth, or low birth weight, the WHO stated.
To mitigate these risks, the new guidelines recommend key interventions including folic acid and iron supplementation—with adjustments in malaria-endemic regions—management of sickle cell crises and pain relief, infection and blood clot prevention, prophylactic blood transfusions, and continuous health monitoring of both mother and baby throughout pregnancy.
WHO experts believe these guidelines could be transformative, empowering pregnant women with SCD to make informed decisions about their care tailored to their individual needs.
“This supports informed decisions about any treatment options to continue or adopt, as well as agreement on how to handle potential complications, so as to optimize outcomes for the woman, her pregnancy, and her baby,” said Dr. Doris Chou, WHO Medical Officer and lead author of the guidelines.
The release of these guidelines coincides with ongoing efforts in countries like India, which recently launched the National Sickle Cell Anaemia Elimination Mission in July 2023.
The initiative aims to eradicate SCD by 2047 through awareness campaigns, universal screening, and comprehensive disease management, particularly targeting vulnerable tribal populations. The mission adopts a community-based and integrated approach, emphasizing grassroots interventions to combat the disease effectively.