WHO issues new global guidelines for managing sickle cell disease in pregnancy

WHO issues new global guidelines for managing sickle cell disease in pregnancy | Image Credit: © Yurii Kibalnik - © Yurii Kibalnik - stock.adobe.com.

New evidence-based guidelines have been published by the World Health Organization(WHO) for treating sickle-cell disease (SCD) in pregnant women, according to an article published in Pregnancy.¹

Nearly 7.74 million individuals worldwide are impacted by SCD, often leading to severe anemia, opportunistic infections, cerebrovascular disease, vaso-occlusive crises, and premature death.² The guidelines were designed to support providers in providing high-quality care that improves outcomes in affected women, alongside highlighting the complex link between SCD and pregnancy.¹

“Although their pregnancies are deemed to be high-risk, there is little guidance available to support optimal care for pregnant women with SCD in moderate- and high-prevalence contexts,” wrote authors.

A global, evidence-based approach

When developing the new guideline, investigators noted only 5 guidelines had recommendations about managing SCD in pregnant women. The WHO guidelines are the first to provide comprehensive, evidence-based recommendations that can be applied in all contexts worldwide.

The guidelines, in particular, consider low- and middle-income countries (LMICs), where SCD has a greater impact. They were developed through a comprehensive appraisal of scientific evidence and can be used to inform policymaking alongside supporting health care workers.

Investigators developed the guidelines by addressing 8 questions relating to pressing issues faced by women with SCD and their caregivers. Alongside reducing these burdens, the guidelines aim to address the efficacy, safety, feasibility, and cost-effectiveness of interventions. Eight systematic reviews were assessed.

Key recommendations for treatment

The guideline development group (GDG) created 20 recommendations about managing SCD in pregnancy. This included treatment through the use of dietary supplements, medications, and prophylactic blood transfusions.

Treatment was also discussed through fluid management, pain management, and thromboprophylaxis. Pregnant women with SCD may present with additional risk factors for thromboembolism, such as prior venous thromboembolism, requiring clinicians to follow local recommendations for thromboprophylaxis initiation.

Pain medication includes nonsteroidal anti-inflammatory drugs, oral paracetamol, and the lowest effective dose of opioids. Iron supplementation was not recommended unless patients present with iron deficiency.

Interpregnancy care, fetal monitoring, and mode and timing at birth were also highlighted. Authors noted the importance of remarks accompanying these recommendations, explaining the rationale behind them and providing contextual considerations.

Considerations for pregnancy and birth

Considerations included acknowledgement of vital issues experienced by women with SCD and their families throughout the reproductive cycle. This is vital for women residing in LMICs, where 95% of maternal mortality was reported in 2020. Applicable WHO guidance that already exists was also recommended to provide a positive pregnancy experience.

These new recommendations provide more focus on SCD and its influence during pregnancy, bringing vital support to care providers that may improve maternal and infant outcomes. Investigators recommended well-planned, consensus-driven implementation of evidence-based policies to improve SCD management.

Further research was also suggested to fill evidence gaps about improving outcomes in pregnant women with SCD and their infants. This research may lead to future WHO recommendations about prenatal SCD with a stronger evidence base.

“Pregnant women with SCD deserve skillful care that effectively manages the risks associated with their pregnancy, while supporting as positive an experience of pregnancy, childbirth, and the postnatal period as possible,” wrote investigators.

References

1. Williams MJ, Ramson JA, Afolabi BB, Chou D. New WHO recommendations on the management of sickle-cell disease in pregnancy. Pregnancy. 2025. doi:10.1002/pmf2.70069
2. Ware RE, de Montalembert M, Tshilolo L, Abboud MR. Sickle cell disease. Lancet. 2017;390(10091):311-323. doi:10.1016/S0140-6736(17)30193-9