The World Health Organization’s first global guideline on Sickle Cell Disease in Pregnancy includes 21 evidence-based recommendations. These aim to improve outcomes for mothers and babies. Here’s a categorized summary of the key tips:

Medication management for women with SCD presenting for antenatal care

• Pregnant women with SCD previously controlled with hydroxycarbamide (hydroxyurea) should consider continuing or restarting the medication after the first trimester. This decision should be made with shared input involving the woman and a multidisciplinary team. The team should include experts in SCD and pregnancy. Base risk–benefit analyses on the woman’s symptom severity, stage of pregnancy and her views and preferences.
• Pregnant women with SCD living outside malaria endemic areas should continue daily folic acid supplementation. The recommended dose is up to 5 mg. If they haven’t started, they should initiate supplementation at this dose as soon as possible.
• Pregnant women with SCD who are on intermittent preventive treatment with sulfadoxine-pyrimethamine should take folic acid supplements. They should consume 400 µg of folic acid daily. Higher doses may counteract the efficacy of the antimalarial.
• Pregnant women with SCD do not require iron supplementation unless there is evidence of iron deficiency.
• Pregnant women with SCD who are iron deficient, should use iron supplementation as for the general pregnant population.

• Consider prophylactic blood transfusion for pregnant women with SCD and a history of severe intractable crises (i.e. recurrent painful crises and/or events unresponsive to other treatment modalities) or with lived experience of previous benefit from prophylactic transfusion outside of pregnancy, .
• For pregnant women with SCD (not hospitalized), consider additional risk factors for thromboembolism (e.g. prior venous thromboembolism [VTE] following vaso-occlusive events) and follow local recommendations for initiation of thromboprophylaxis for pregnant women with elevated risk of thrombotic events (e.g. prior VTE, obesity, inherited thrombophilia).
• Pregnant women with SCD, should not go through routine infection prophylaxis. Implement frequent screening for infection, such as urinary tract infection. Use a low diagnostic threshold for bacterial urinary tract infection.

Pain management for pregnant women with SCD

• pregnant women with SCD who are experiencing acute sickle-related pain, should receive timely and optimal pain relief.
• When advising use of analgesia, several options are available. These include oral paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or opioids. Use opioids at the lowest effective dose for the shortest period of time required to manage pain.
• When advising use of analgesia, consider the stage of pregnancy and contraindications for specific medications. Take into account the woman’s views, preferences, and previous experience of the medication. Assess the risk of dependence and availability.
• Collaborate with pregnant women with SCD to develop individualized pain management plans as early in pregnancy as possible, basing the plan on severity and frequency of pain crises, the woman’s views and preferences, and including a multidisciplinary team approach to care

Management of women with SCD who are hospitalized during pregnancy

• Pregnant women with SCD hospitalized with vaso-occlusive crisis and requiring intravenous fluid hydration should receive frequent clinical monitoring. This includes lung auscultation, oxygenation/pulse oximetry, and respiratory rate checks. The goal is early identification of fluid overload and pulmonary oedema.
• Pregnant women with SCD requiring intravenous fluid hydration need more intensive monitoring. This is crucial in cases with obstetric complications such as pre-eclampsia to monitor for signs of fluid overload.
• Offer thromboprophylaxis to pregnant women hospitalized with SCD unless contraindications are present.

Fetal monitoring

• Pregnant women with SCD without complications (due to SCD or to obstetric causes) should receive growth/biometric scans. These scans identify fetal growth restriction every four weeks from 24 until 32 weeks’ gestation. Then, conduct them every three weeks until birth.
• Pregnant women with SCD and complications, either due to SCD or obstetric causes, should receive individualized intensive fetal monitoring. This helps guide management. Consider the woman’s views and preferences. Also, consider the availability of equipment and staff skilled in their use.

Care around birth

• When making decisions about the timing of birth (awaiting spontaneous labour or planned birth) for women with SCD, take an individualized approach based on the anticipated balance of the benefits of continuing pregnancy to allow fetal maturation and the risk of maternal and neonatal morbidities associated with continuation of the pregnancy, and the woman’s views and preferences
• Base decisions about mode of birth for women with SCD on medical or obstetric indications. Consider if there is a need for a caesarean birth. Consider the availability of local resources, including those required by women to make informed decisions. Also take into account the woman’s views and preferences. In the absence of medical or obstetric indications for caesarean birth, vaginal birth is preferable.
• Provide care to women with SCD in the immediate postnatal period. Continue this care up to six weeks after childbirth. This care is additional. It is outlined in WHO recommendations on maternal and newborn care for a positive postnatal experience.
• For women with SCD, integrate care across the life course, including sexual and reproductive health care, with specialized disease care, which may include: supporting optimal health; providing pre-pregnancy counselling and guidance on pregnancy planning; and optimizing treatment across the reproductive continuum

These comprehensive WHO recommendations are a significant step toward reducing the care gap for pregnant women with sickle cell disease. This is especially important in high-burden, low-resource settings like much of Sub-Saharan Africa. They prioritize customized, compassionate, and interdisciplinary care throughout the pregnancy, from nutrition and crisis management to delivery and postnatal support. When followed, these guidelines can help reduce avoidable deaths. They improve outcomes. They enable women with SCD to have safe, healthy pregnancies.