Sickle Cell and Pregnancy
There have been many questions on the Sickle Cell Warriors Facebook page regarding being pregnant with sickle cell. Many of the women have shared their experiences with pregnancy, labor and delivery.
The one consistent theme is that each and every person has a different experience. You have to remember that just because Lucy had a rough pregnancy doesn’t mean that you will to. Being pregnant with sickle cell works about the same way being pregnant without sickle cell—you never know what’s going to happen. You could have a smooth, easy pregnancy period, and successful labor. You could have a rocky start, with nausea, vomiting, and pregnancy complications. It really just depends on how your body deals with the pregnancy and the stresses that it places on everybody.
I think that alot of moms to be are super worried about being pregnant—and with just cause. However, having sickle cell doesn’t guarantee you a rocky pregnancy…in fact, some moms have stated that their health was the best that it’s ever been while they were pregnant. One lady said that she never even had a crisis the whole time she was pregnant. While she might be the exception and not the rule, it’s heartening to know that just because you have sickle cell doesn’t automatically mean that you can’t have kids, or that you will have a rough time with pregnancy, labor and delivery.
Now we are going to discuss some of the pertinent facts about pregnancy and sickle cell.
The first thing is that if you are trying to get pregnant, or as soon as you find out that you are pregnant, STOP TAKING HYDROYUREA! This medication, although good with managing sickle cell for some patients, has been shown to increase the risk of congenital birth defects and abnormalities. So for the sake of your baby, put the Hydrea away asap.
The second question is that alot of moms worry about taking pain pills when you are sick. You should avoid taking alot of pain pills the first 3 months of your pregnancy. This is when the baby is just developing, and pills during the first trimester have the possibility of leading to birth defects. It is important that whatever pain regimen you are on, that you make sure the pills are Class B or Class A. The classes define whether they cross the placental barrier.
For Class C drugs (most opiates), there is no research that has followed the safe levels of narcotics during pregnancy, so use these in the smallest dose possible and only if you are in extreme pain that nothing else works. Doctors do allow narcotics in small doses and sporadically (once in a while) as long as the benefit outweighs the risk. If you need heavier doses, you may have to be admitted for pain management during a crisis (as I was). Risks to your baby include miscarriage, preterm labor, still birth, low birth weight, respiratory issues, or excessive drowsiness. Let your doctors know exactly what pain meds and how much you are taking.
Aspirin: Should not be taken routinely, unless your doctor has prescribed it for blood clots or preeclampsia.
Oxycodone: Children born to mothers who were taking oxycodone for a prolonged period may exhibit respiratory depression or withdrawal symptoms. Oxycodone is also secreted in breast milk in small amounts, so be sure to pump and dump after you take Oxycodone.
Tylenol: Is considered safe for the whole pregnancy, in all 3 trimesters. But if you have had liver problems, you might want to limit your use of Tylenol.
Dilaudid: Is a Class C drug, and is not recommended while pregnant. However, a couple of moms reported using Dilaudid in their 3rd trimester, with no issues to the offspring.
Motrin: Is fine in the first 2 trimesters, but not in the 3rd trimester because of the risk of bleeding. This applies to other NSAIDS like Aleve, Advil & Naproxen.
Methadone: This does not cross into breast milk and because of its long-acting properties with no peak, it is preferred by high risk OBGYNs as a pain medication adjunct or a good long-acting coverage. You need to start on a low dose and gradually increase until desired effect. It has to be taken at the same time every day, never missing a dose. It takes 3-5 days to feel a therapeutic effect. You cannot stop taking Methadone suddenly, you must taper or wean off.
For Women with Sickle Cell Trait: Pregnant women with SCT are at greater risk for frequent urinary tract infections and developing iron-deficiency anemia than other pregnant women and will require iron supplementation, but they have no extra risks associated with being a carrier.
For Women with Sickle Cell Disease: Women with SCD are more likely to have life-threatening complications during pregnancy, which may include SCD crises, infection (e.g., pyelonephritis, pneumonia, sepsis, postpartum infection), preeclampsia, cerebral vein thrombosis, pulmonary embolus, deep vein thrombosis (DVT), cholelithiasis (i.e., gallstones), cholecystitis (i.e., inflammation of the gallbladder), cardiomegaly (enlarged heart), myocardial infarction (MI), heart failure, or postpartum hemorrhage (bleeding). Preexisting renal disease or heart failure secondary to SCD may worsen during pregnancy. Anemia and circulatory problems in SCD can result in less oxygen delivered to the fetus, resulting in miscarriage, slower fetal growth, stillbirth, and neonatal death. Fetal complications include intrauterine growth restriction (IUGR), preterm birth (prior to 37 weeks of gestation), and low birthweight. These risks are also present in women without SCD, it’s just that we are at a higher risk for developing said complications.
So what can you do to manage your pregnancy with Sickle Cell Disorders? Early and regular prenatal care is essential for close maternal and fetal monitoring. General pregnancy care includes a healthy diet, low-impact light exercise, prenatal vitamins, folic acid, increased fluid intake, and prompt treatment of infections and crises. Blood transfusions to replace abnormal cells with normal ones in order to improve the blood’s oxygen-carrying capacity may be required for women with a history of frequent SCD crises. Getting too much IV fluids during pregnancy may lead to heart failure, so be sure not to get more than 3L/day if you are going to get intravenous fluids. During labor, a woman with SCD will receive extra oxygen.
It is important that you practice good self care during your pregnancy. Exercise. Hydrate. Rest. Eat Healthy. These are all tips that you should be incorporating into your life anyway, and while pregnant, you should be hyper-vigilant to prevent a crisis and help your baby grow. If you do have a crisis while pregnant, call your doctor right away, as medical interventions may be required to support your baby’s health. If you are having multiple crisis, ask for a neonatal specialist to help monitor your babies’ health in the womb. Become best buds with your OBGYN, and as a further precaution, get a high risk OBGYN that can help you during your transition into motherhood. Continue to see your Hematologist and other physicians as required. Remember, your baby is only as healthy as you are.
Good luck with your pregnancy, and I hope that you put your fears to rest. Know that no matter what issues you go through: even if you are put on bedrest, or have a topsy turvy pregnancy, God is in control. There is a reason He let you get pregnant, and so embrace motherhood with all the joys and surprises that it may bring. At the end of the day, you will have a beautiful baby. So preservere my warrior ladies.