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Sickle Cell and Pregnancy

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.

References: Bedoe, A.E & Pravikoff, D. (2010) Sickle cell and Pregnancy. Cinahl Information Systems. Access #20100115.
Marti-Carvajal, A. J., Pena-Marti, G. E., Comunian-Carrasco, G., & Marti-Pena, A. J. (2009). Interventions for treating painful sickle cell crisis during pregnancy. Cochrane Database System Review, (1), CD006786.

Related posts:

Sickle Cell and Pregnancy - overview

Summary: Updated with latest narcotic recommendations as of 2015, this guide gives some insight to what challenges being pregnant with sickle cell can bring. But hopefully at the end, you will have a bouncing baby to lighten your life!

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Sickle Cell Warrior

Sickle Cell Warrior

Tosin is dedicated to perpetuating healthy and positive messages about sickle cell. Although sickle cell is a subject often taboo in the communities this condition is most prevalent, Tosin’s message is that sickle cell is not something to be ashamed of and you can live a rich and fulfilling life with sickle cell. Sickle cell warriors are the most amazing people in the world, with a great fortitude for compassion, willpower and strength.

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25 Comments

  1. Makanjuola Tolulope
    Makanjuola Tolulope October 25, 08:29

    Hi Tosin, I really commend the good work you are doing, may God continue to bless and strengthen you. I would like to say I really enjoyed the interviews, its really interesting and educating. I would like to advise warriors to always have a positive attitude, a good state of mind, and think good about themselves because our actions reveals our thoughts. Sickle cell warriors should be positive in their thinking and should never be intimated by anybody or allow anybody see you differently.

    This is just my own little way of contributing. God bless.

  2. Sickle Cell Warrior
    Sickle Cell Warrior Author November 30, 11:57

    @Tolu, great points, you are right. Having a positive attitude is often the only thing that can pull you through in times of crisis. There is a warrior interview I did last year about Nick, a sickle cell warrior who uses humor to get through any situation. we can be upset, and cry, and have a pity party, but that really gets you no where.

  3. Vee
    Vee March 19, 05:23

    I found out I was pregnant at 1 month. I was so excited. What I did not know is that I will be taken for lifetime of pain and suffering. It started out with dehydrated. I fell out in a bank in August. I thought going to school full time and working full time was at ease. Then I caught pneumonia in September. I lived alone and had no children. Then the end was near, it was December, 39 weeks. I went in cause I kept having Braxton hicks pains, then my leg had gotten extremely swollen. Went in to the ER after entering every week for the past 4 weeks begging to have a C-section. Now I’m in for this and like every visit they sent me home. But wait, this doctor thinks its a sickle cell crisis. So he does a sonogram on my baby. You might think I should be in tears for this part, but I was in to much pain from my leg. I was 27yrs old and the dad was near me. The doc says that they found fluid in the brain and need an emergency C-section. I, in too much pain to react just let them do what they had to do. December 18,2009, I saw a beautiful little girl. She was in the room for no more than 3 minutes and was rushed to no idea. Long story short. My amazing princess has cerebral palsy. She had 2 strokes and a seizure within 24hrs of her birth. One in which my mom held her in the NICU. I did do an investigation influenced by my mom, and found out what really happened. My Sickle beta plus thalassemia was giving her blood clots through the cord. My oxygen level was low, but all pregnancies are like that. Well, mines put she and me at risk of dyeing. She came out 8lbs 10oz. I don’t ever get so sick, but ever since my pregnancy I do have crisis a lot. My daughter had to have OT, PT, speech therapy and an instructor to come in and help. She’s still not saying words, but started to gesture now. She walked at 20 months cause the stroke left her whole left side low coordinated. She’s doing great compared to her first 24hrs on earth. I had to stop working and attending school due to her therapy and not talking. I’m trying to be strong, but…. its hard. I’m thankful for her because she is everything I’ve ever wanted. I know in the beginning I wanted a healthy baby, but after everything, I’m happy what we got going. Just take care of yourself if pregnant with sickle cell. You would never think sickle cell can cause so much in a person’s life. I had to change a lot about me, never in my wildest years, but I had to drop her dad. He was never supportive knowing what our daughter been through. Just pray to God and don’t worry. Take very, and I mean very good care of yourself and you and your blessing will be find.

  4. Blessing
    Blessing April 03, 01:56

    I love de way you talk In all ur speech u crown it with God.

  5. jumoke
    jumoke May 03, 09:37

    Vee, its hard τ̲̅ȍ go through all this, buh thank God you still love God, Ɣø̲̣U̶̲̥̅̊ love ur daughter aήð taking care of her. Pregnancy is †ђξ most dread part of a Sickle cell female patient’s life. You may choose to go on Solamin steady before getting pregnant. Though I had little crises when I was pregnant with ♏♈ boy, but I had a considerably smooth pregnancy period, thanks τ̲̅ȍ ♏♈ local herbs drink from Nigeria that kept me on a PCV of 30 above throughtout pregnancy. Any1 willing τ̲̅ȍ try d herbs can email me (lajumoke1@yahoo.com). I stay steady on d herbs rather than folic acid, aήð I have nƠ̴̴̴̴͡†̥ had crises that has taken me to d hospitall in d last 4 yrs. I Jйʃ† heard about solamin from here as well. Take care andd stay blessed all.

  6. vee
    vee June 13, 21:48

    Thank you. And yes, thank God we have him. Maybe one day I’ll try these herbs. Because of your pregnancy, it gives hope to believe that everything will be all right. I want more, but I’m not in any rush. May God bless you all.

  7. JoyousJoy
    JoyousJoy June 23, 11:16

    Vee, my prayer is that the God who created the whole universe, the One who is the Sustainer of all, may shower you with all heavenly blessings that you need every second and that He may carry your little one always in His loving healing and protective arms, Amen.

  8. Paula Kent
    Paula Kent June 26, 05:21

    Yes, it is possible to carry the pregnancy to full term and have a health baby. I am 31 living positively with SCD though I have no children of my own as at now. My sister who is 37 years and also has SCD, delivered a healthy son 14 years ago.

    Her pregnancy had its equal shares of challenges since she was taken in for hospital bed rest at 6 months, but through the grace and strength from the Almighty God, she emerged victorious! The medical staff at Kenyatta National Hospital in Nairobi Kenya were very supportive as well.

    Amen!!

  9. Carm
    Carm April 13, 21:48

    I am a 39 year old woman with SCD (SS at that). I had my first child at 29 and I must say the pregnancy went very smooth. I had blood transfusions once a month until I was induced two weeks early because at that point I started having crisis’. I’m now 39 and pregnant with my second child. I’m only 10 weeks along and have had some crisis, the flu, some nausea and back pain. My doctor recently asked me if I thought about my life expectancy and I said yes and no. With SCD you have to be aware of what can happen but deffinitely not dwell on it and always be positive. I only pray that I will have as smooth a pregnancy as I did with my first child however that is all in the hands of The Lord. I just want people to know that you just have to stay positive and it is possible for a woman with SCD to have children. All pregnancies are different even without SCD there can be so many different complications. Whether you have SCD or not if you are going to try to get pregnant just go for it and leave the rest up to God. I’m a strong believer that I was the one in my family to have SCD because only I could have handled it how I have.

  10. lissa
    lissa May 13, 03:06

    @tosin…dis is a beautiful forum dear…d gud lord who made us surely has a gud plan to keep us safe,well,and healthy.be steadfast in ur prayers and stay positive as much as u can.i do appreciate ur encouragement and work dear.
    @carm i am strongly against ur doctor asking about ur life expectancy,lots nd lots of people live with scd for over 60years, its learning how to manage your self,thats all,some people without any form of illness die without notice,so take ur meds,stay positive and God bless.5Thanks.

  11. jessy
    jessy January 29, 07:50

    am 38 year old girl living with scd .i recently got married to the love of my life who is AA. am afraid to take in as a doctor has advised me against it once am in late 30’s .i love kids and i want to have 2

  12. Abis
    Abis March 10, 09:37

    I am ss but my husband is AA we ed in the church an he love me very well,i want to be pregnant but am having left hip necrosis,for 8yrs now can i still be pregnant?for yrs now i have never been admited in the hospital or have any crises,i work in the hospital inside cool,do hevy work but thank God for every thing pls advice me on what to do

  13. FutureMrsW
    FutureMrsW April 14, 16:02

    Hey warriors I hope u can help me…. So my question is long and it is a bit TMI but I had to give the background info..

    I am a 26 year old sickle cell SS patient. My fiancé and I have been using the pull out method for 2 years. On March 29 I ovulate and he pulled out, we had sex several times after that and all times he pulled out.

    I am now 4 days late (my period is never late ever ). I am EXTREMLY sleeply all the time I have only been out of bed for 4 hours in the past 24 hours. Other than some very light on and off again cramps I have no pms symptoms and other than being tired, a lil nauseated and flu like symptoms including a low grade fever I have no pregnancy symptoms.

    About a week after I ovulated I started to get really bad cramps so bad o had to take an Epsom salt bath. I also got really bad acne breakout on my forehead.

    I went to the to the doctor today and she did a iron test and determined that I am not pregnant. After examining my stomach and finding that I had some discomfort in the upper right hand corner she concluded that it was my gallbladder. She ordered blood work to check the functioning of my gallbladder, pancreas, Liver etc but no pregnancy test….a she said she is not worried about my period being late because the lateness can be due to the gallbladder..

    Now being a sickle cell patient I have had 2 gallbladder attacks in the past and this feels nothing like them. I don’t have a heart time eating anything I’m not in pain and I’m not vomitting. I eat extremely healthy and other than occasionally salmon and a daily slice of avocado my fat intake is low. Besides with all the sickle cell complications I’ve had I have NEVER missed a period.

    Can my gallbladder really cause my missed period?

  14. Sickle Cell Warrior
    Sickle Cell Warrior Author April 17, 20:56

    @FutureMrsW, I’m not sure if your gallbladder can cause a missed period. But anemia often causes missed periods as if your blood level is low, your body will not want to let go of the little hemoglobin that you have. I would suggest retaking the pregnancy test just to be sure.

  15. Sickle Cell Warrior
    Sickle Cell Warrior Author April 17, 21:12

    @Abis, know that your pregnancy may make your AVN worse because of the excess weight, you may have more pain. You might want to get a hip replacement before or after the baby. if your husband is AA you can get pregnant. Your children will all have sickle cell trait, but not the disease. Make sure you educate them so they don’t pass it on to the next generation. Know that your pregnancy, labor, and delivery may be hard and challenging. You must find a high-risk OBGYN and a hematologist to be on your case before your get pregnant to receive the very best care. It is risky, but at the end of the day you will have the joy of a bouncing baby boy or baby girl. Good luck and please keep in touch.

  16. Sickle Cell Warrior
    Sickle Cell Warrior Author April 17, 21:34

    @Jessy, I was 35 when I had my twin boys. Have faith, pray, and make sure you have a hematologist and high risk OBGYN. If you need fertility treatment to get pregnant, so be it. Or you can go ahead and adopt. Don’t let sickle cell stop you from your dream of being a mom!

  17. G4ndz
    G4ndz April 27, 04:56

    I am in love with a lady thats got sdc(ss) ,I am optimistic that I want to spend the rest of my life with her, so I have been doing a lot of research about Sdc(ss) online and thats how I came accross this website, I must say its really nice and educating and also sheds alot of light about all it takes to manage someone with Sdc and also have a successful pregnancy. I look forward to be more enlightened with time . Thanks

  18. sharkeybom
    sharkeybom October 30, 00:51

    Weldone job here, please keep it up. Please, what is the best fertility drug for a sickle cell patient?

  19. chigyrl
    chigyrl December 12, 04:46

    Your comment..am happy about this forum, am also pregnant and have had 2 blood transfusion, its been God all through but i cant stop craving for nzu and i feel tired easily, am in my 3rd trimester, please dont stop praying for me

  20. Kobe
    Kobe January 12, 01:48

    I have a question if someone with sickle cell have a miscarriage how long do they bleed afterwards ?

  21. bubblegal
    bubblegal January 22, 13:20

    thanks warriors for encouragement
    am 22years with sickle cell.I have a hip dislocation….
    am 3months pregnant,,am happy about it and am positive that I will outcome the challenge s

  22. Sickle Cell Warrior
    Sickle Cell Warrior Author January 22, 18:59

    It’s not related to your sickle cell. You should consult with your doctor if you are still bleeding. Having sickle cell will not make your bleed more or less, but it can trigger a crisis. Please call your doctor.

  23. Sickle Cell Warrior
    Sickle Cell Warrior Author February 14, 01:27

    Sorry. I’m not sure. Please ask your doctor. Perhaps a hematologist or obgyn.

  24. farheen
    farheen February 15, 01:28

    sir can you suggest me a natural remedies I can take during pregnancy because I can’t take hydroxy urea….on that time…plzzz guide me

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