Precautions required by a sickle cell disease sufferer before she conceives

If a SCD sufferer is planning to become pregnant, she should see her doctor, who will need to sort out a few things.

One will be to offer counseling regarding the potential problems and outcome. There will also be genetic counseling. Since a SCD sufferer will inevitably pass on a defective gene to the child, it is important that the status of the partner is established, in order to calculate the chances of the child being affected and to what degree.

For instance, if the father is neither a sufferer nor a carrier (i.e. he has normal hemoglobin), the child will inherit a defective gene from the mother and a normal gene from the father. This means the child will be sickle cell trait or a carrier. This and all the other possible permutations have to be discussed and fully understood.

The other important aspect to be dealt with is the mother's pre-conception general health. For instance, sickle cell disease tends to affect the kidneys in particular. It is imperative therefore that kidney function is assessed, to ensure that they can take the extra strain placed on them by pregnancy.

Finally, it is important that the mother's overall health status is optimized, so she can start her pregnancy from a relatively healthy position.

Special measures for a Sickle Cell Disease (SCD) sufferer during pregnancy

Nothing can substitute meticulous prenatal care. Apart from the general measures that every pregnant woman benefits from, SCD sufferers will need regular screening of their liver and renal (kidney) function, and checks for possible urinary tract infection and development of such complications as pre-eclampsia.

The single most important measure will be to monitor her hemoglobin (Hb) level. Many affected women will require blood transfusion, sometimes several times, during pregnancy.

The need for blood transfusion for a SCD sufferers in pregnancy

These women are chronically anemic and pregnancy will inevitably worsen this. Anemia puts a strain on vital organs, including the heart, and weakens the individual. This has to be prevented as much as possible.

Moreover, by giving sufferers "normal" blood, the proportion of defective blood is reduced. This reduces the chances of sickling crises. Sickling could be potentially catastrophic in pregnancy as these episodes are directly responsible for many - if not most - of the fetal losses in sufferers.

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