World Sickle Cell Day: Sickle cell and pregnancy

Pregnancy for people with sickle cell is a high-risk situation.

Anyone living with sickle cell disease will tell you how stressful life can get when you have to manage your life around the disorder, and this is especially true if the person has to bring another human being into the world. "Sickle cell disease is a genetically transmitted disorder disorder of the beta chain in the human haemoglobin due to a change in the gene structure (mutation)that a person inherits from the parents in an autosomal recessive pattern," says Haematologist Dr Abhay Bhave.

It is a well established fact that if the person has sickle cell anaemia, it could pose grave threat to the mother and the child. Dr Bhave says, "The disease can have a bearing on pregnancy, and the health and well-being of the mother and the foetus can be gravely affected if the patient is not counselled well before pregnancy or not adequately monitored during the pregnancy."

However Dr Bhave says that a sickle cell trait (less than 50% sickle cell disorder also called as minor) most often does not have too many issues during pregnancy. Read: Sickle cell: What are the treatment options?

The difference between sickle cell trait and sickle cell disease

To understand these risks, it is important to know the difference between sickle cell trait and sickle cell disease. A sickle cell trait is when the person has inherited the sickle cell gene from one of his parents. But sickle cell disease, on the other hand, is a genetic condition that leads to the hardening of blood cells due to their abnormal 'C' or sickle-shaped form and is inherited when the child receives two sickle cell genes from each parent.

"But unlike sickle cell disease, there is no way to recognise any symptoms of sickle cell trait. The person doesn't have any symptoms. Such people are diagnosed inadvertently on a CBC test where such sickle cells are seen on the smear or if a routine haemoglobin electrophoresis has been done and the S band is identified," says Dr Bhave.

Inheriting sickle cell

"If both the parents have the trait, there is a 25 percent chance that the child will have sickle cell disease / anaemia or 25% normal status ( ie no sickle cell) . There is a 50% chance that the child will be a sickle cell trait like them and will not have any of the undesirable symptoms of sickle cell disease. However, they can still pass it on to the next generation," adds Dr Bhave.

If only one parent has sickle cell trait, there is a one in two chance of the chill having sickle cell trait or not having sickle cell trait.

Sickle cell and pregnancy complications

During pregnancy, there is a risk of perinatal mortality, premature labour, inadequate foetal growth for those with SCD. There are studies that suggest an increase in the incidence of spontaneous miscarriage, maternal deaths, infection and haemorrhages. Women with sickle cell trait may not have as many complications.

Can people with sickle cell traits have a healthy pregnancy?

Pregnancy with sickle cell trait or disease is a high-risk situation. Before the woman gets pregnant, both the man and the woman should get themselves checked if they have sickle cell traits or if the traits run in the family. The person with the traits should, therefore, make an informed decision and know the risks before having children. Talking to the doctor or a genetic counsellor can help.

Even during pregnancy, a prenatal test can be done to determine whether the unborn child is carrying sickle cell traits or sickle cell disease. In the second month of pregnancy, an amniocentesis test can be carried out for the same purpose.

"Usually, when the mother has sickle cell trait, we don't prescribe treatment," says Dr Bhave. However, if she has sickle cell disease/anaemia, prenatal care and constant monitoring of foetal and maternal health should be done throughout the pregnancy. "The mother has to be supplemented with folic acid and vitamin, and in some cases, blood transfusions may be required," adds Dr Bhave.

Image source: Shutterstock